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The Correlation Between Serum Homocysteine Levels and Hypothyroidism: a 1-Year Case Control Study
Corresponding Author(s) : Dr. Anjali R. Metgudmath
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 5 No. 2 (2017): 2017 Volume 5- Issue -2
Abstract
Background
Thyroid hormones have significant effects on lipid metabolism and homocysteine levels. Decrease in thyroid hormone levels may alter the homeostasis of lipid metabolism and homocysteine levels.
Objectives
To study the incidence of hyperhomocysteinemia and hypercholesterolemia in patients with hypothyroidism, and to find out the correlation of homocysteine with cholesterol levels, thyroid hormones and thyroid-stimulating hormone (TSH) in newly detected hypothyroid patients.
Methods
In this prospective case-control study, 30 hypothyroid patients (case group) and 30 euthyroid controls were included. Patients with a TSH level >4.78 mIU/mL were considered in the case group and those with TSH level <4.78 mIU/mL were included in the control group. Cases and controls were matched on the basis of age, sex, and body mass index. Levels of TSH, free T3 andT4, fasting serum homocysteine, and total cholesterol were investigated in both case and control groups. The data were statistically analysed with Independent t-test and Pearson’s correlation method by SPSS 20.0.
Results
Compared to controls, significant increase in serum homocysteine levels was observed in in hypothyroid group (P = 0.0064). Serum total cholesterol levels were significantly higher in hypothyroid group when compared with control (P = 0.0066). Correlation of serum homocysteine levels with the levels of TSH, free T3 and T4, and serum cholesterol levels were statistically not significant in both hypothyroid group.
Conclusion
We observed a significant increase in levels of homocysteine and total cholesterol levels in hypothyroid group when compared with control. Hyperhomocysteinemia and increased cholesterol levels can contribute to cardiovascular risks. We recommend screening of serum homocysteine levels in hypothyroid patients to detect atherosclerosis and cardiovascular diseases.
Keywords
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Rizos CV, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J, 5, 2011, 76-84.
[2]. Bamashmoos SA, Al-Nuzaily MA, Al-Meeri AM, et al. Relationship between total homocysteine, total cholesterol and creatinine levels in overt hypothyroid patients. Springerplus, 2, 2013, 423.
[3]. Evrengul H, Tanriverdi H, Enli Y, et al. Interaction of plasma homocysteine and thyroid hormone concentrations in the pathogenesis of the slow coronary flow phenomenon. Cardiology, 108(3), 2007, 186-92.
[4]. Coffey M, Crowder GK, Cheek DJ. Reducing coronary artery disease by decreasing homocysteine levels. Critical Care Nurse, 23(1), 2003, 25-30.
[5]. Nygard O, Nordrehaug JE, Refsum H, et al. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med, 337(4), 1997, 230-6.
[6]. Shah Kruti N, V GP. Hypothyroidism and atherosclerosis: From etiology to pathophysiology. Scholars Academic Journal of Pharmacy, 3(1), 2014, 89-96.
[7]. Lu M, Yang CB, Gao L, et al. Mechanism of subclinical hypothyroidism accelerating endothelial dysfunction (review). Exp Ther Med, 9(1), 2015, 3-10.
[8]. Refsum H, Ueland PM, Nygard O, et al. Homocysteine and cardiovascular disease. Annu Rev Med, 49, 1998, 31-62.
Anjali R. M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-5(2) 2017 [611-615]
615
[9]. Antoniades C, Antonopoulos AS, Tousoulis D, et al. Homocysteine and coronary atherosclerosis: From folate fortification to the recent clinical trials. Eur Heart J, 30(1), 2009, 6-15.
[10]. Turhan S, Sezer S, Erden G, et al. Plasma homocysteine concentrations and serum lipid profile as atherosclerotic risk factors in subclinical hypothyroidism. Annals of Saudi medicine, 28(2), 2008, 96.
[11]. Rahbani-Nobar M, Bahrami A, Norazarian M, et al. Correlation between serum levels of cholesterol and homocysteine with oxidative stress in hypothyroid patients. International Journal of Endocrinology and Metabolism, 2(2), 2004, 103-9.
[12]. McNulty H, Pentieva K, Hoey L, et al. Homocysteine, b-vitamins and cvd. Proc Nutr Soc, 67(2), 2008, 232-7.
[13]. Zhang Y, Wang Q, Li Q, et al. Association between hyperhomocysteinemia and thyroid hormones in euthyroid diabetic subjects. Biomed Res Int, 2015, 196379.
[14]. Molham Ali Al-Habori, Ali Mohammed Al-Meeri, Mohammed Abdulkader Al-Nuzaily, et al. Homocysteine level in relation to thyroid function tests in hypothyroid patients. Asian Journal of Medical and Pharmaceutical Researches, 4(2), 2014, 101-6.
[15]. Dong X, Yao Z, Hu Y, et al. Potential harmful correlation between homocysteine and low-density lipoprotein cholesterol in patients with hypothyroidism. Medicine (Baltimore), 95(29), 2016, e4291.
[16]. Diekman MJ, van der Put NM, Blom HJ, et al. Determinants of changes in plasma homocysteine in hyperthyroidism and hypothyroidism. Clin Endocrinol (Oxf), 54(2), 2001, 197-204.
[17]. Mayer O, Jr., Simon J, Filipovsky J, et al. Hypothyroidism in coronary heart disease and its relation to selected risk factors. Vasc Health Risk Manag, 2(4), 2006, 499-506.
[18]. Auer J, Berent R, Weber T, et al. Thyroid function is associated with presence and severity of coronary atherosclerosis. Clin Cardiol, 26(12), 2003, 569-73.
[19]. Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine, 24(1), 2004, 1-13.
[20]. Christ-Crain M, Meier C, Guglielmetti M, 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, 166(2), 2003, 379-86.
[21]. Sadeghian S, Fallahi F, Salarifar M, et al. Homocysteine, vitamin b12 and folate levels in premature coronary artery disease. BMC Cardiovasc Disord, 6, 2006, 38.
[22]. Park YJ, Lee YJ, Choi SI, et al. Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects. Eur J Endocrinol, 165(1), 2011, 115-21.
[23]. Tyagi N, Sedoris KC, Steed M, et al. Mechanisms of homocysteine-induced oxidative stress. Am J Physiol Heart Circ Physiol, 289(6), 2005, H2649-56.
References
[2]. Bamashmoos SA, Al-Nuzaily MA, Al-Meeri AM, et al. Relationship between total homocysteine, total cholesterol and creatinine levels in overt hypothyroid patients. Springerplus, 2, 2013, 423.
[3]. Evrengul H, Tanriverdi H, Enli Y, et al. Interaction of plasma homocysteine and thyroid hormone concentrations in the pathogenesis of the slow coronary flow phenomenon. Cardiology, 108(3), 2007, 186-92.
[4]. Coffey M, Crowder GK, Cheek DJ. Reducing coronary artery disease by decreasing homocysteine levels. Critical Care Nurse, 23(1), 2003, 25-30.
[5]. Nygard O, Nordrehaug JE, Refsum H, et al. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med, 337(4), 1997, 230-6.
[6]. Shah Kruti N, V GP. Hypothyroidism and atherosclerosis: From etiology to pathophysiology. Scholars Academic Journal of Pharmacy, 3(1), 2014, 89-96.
[7]. Lu M, Yang CB, Gao L, et al. Mechanism of subclinical hypothyroidism accelerating endothelial dysfunction (review). Exp Ther Med, 9(1), 2015, 3-10.
[8]. Refsum H, Ueland PM, Nygard O, et al. Homocysteine and cardiovascular disease. Annu Rev Med, 49, 1998, 31-62.
Anjali R. M et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-5(2) 2017 [611-615]
615
[9]. Antoniades C, Antonopoulos AS, Tousoulis D, et al. Homocysteine and coronary atherosclerosis: From folate fortification to the recent clinical trials. Eur Heart J, 30(1), 2009, 6-15.
[10]. Turhan S, Sezer S, Erden G, et al. Plasma homocysteine concentrations and serum lipid profile as atherosclerotic risk factors in subclinical hypothyroidism. Annals of Saudi medicine, 28(2), 2008, 96.
[11]. Rahbani-Nobar M, Bahrami A, Norazarian M, et al. Correlation between serum levels of cholesterol and homocysteine with oxidative stress in hypothyroid patients. International Journal of Endocrinology and Metabolism, 2(2), 2004, 103-9.
[12]. McNulty H, Pentieva K, Hoey L, et al. Homocysteine, b-vitamins and cvd. Proc Nutr Soc, 67(2), 2008, 232-7.
[13]. Zhang Y, Wang Q, Li Q, et al. Association between hyperhomocysteinemia and thyroid hormones in euthyroid diabetic subjects. Biomed Res Int, 2015, 196379.
[14]. Molham Ali Al-Habori, Ali Mohammed Al-Meeri, Mohammed Abdulkader Al-Nuzaily, et al. Homocysteine level in relation to thyroid function tests in hypothyroid patients. Asian Journal of Medical and Pharmaceutical Researches, 4(2), 2014, 101-6.
[15]. Dong X, Yao Z, Hu Y, et al. Potential harmful correlation between homocysteine and low-density lipoprotein cholesterol in patients with hypothyroidism. Medicine (Baltimore), 95(29), 2016, e4291.
[16]. Diekman MJ, van der Put NM, Blom HJ, et al. Determinants of changes in plasma homocysteine in hyperthyroidism and hypothyroidism. Clin Endocrinol (Oxf), 54(2), 2001, 197-204.
[17]. Mayer O, Jr., Simon J, Filipovsky J, et al. Hypothyroidism in coronary heart disease and its relation to selected risk factors. Vasc Health Risk Manag, 2(4), 2006, 499-506.
[18]. Auer J, Berent R, Weber T, et al. Thyroid function is associated with presence and severity of coronary atherosclerosis. Clin Cardiol, 26(12), 2003, 569-73.
[19]. Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine, 24(1), 2004, 1-13.
[20]. Christ-Crain M, Meier C, Guglielmetti M, 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, 166(2), 2003, 379-86.
[21]. Sadeghian S, Fallahi F, Salarifar M, et al. Homocysteine, vitamin b12 and folate levels in premature coronary artery disease. BMC Cardiovasc Disord, 6, 2006, 38.
[22]. Park YJ, Lee YJ, Choi SI, et al. Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects. Eur J Endocrinol, 165(1), 2011, 115-21.
[23]. Tyagi N, Sedoris KC, Steed M, et al. Mechanisms of homocysteine-induced oxidative stress. Am J Physiol Heart Circ Physiol, 289(6), 2005, H2649-56.