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Childhood obesity may be linked to altered thyroid
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Children with obesity showed alterations of the structure and function of the thyroid, according to recent findings.
“We found an association between BMI and thyroid hormone levels, which suggests that fat excess may have a role in thyroid tissue modification,” Giorgio Radetti, MD, department of pediatrics, Regional Hospital of Bolzano in Italy, said in a press release.
The researchers enrolled overweight and obese children (n=186) between March 2004 and December 2007.
Group A consisted of children who showed antithyroid antibodies and an ultrasound pattern suggestive of Hashimoto’s thyroiditis (12.4%); Group B included children with antithyroid antibodies and normal ultrasound (10.8%), according to the researchers. Group C included children who showed absent antithyroid antibodies and an ultrasound pattern suggestive of Hashimoto’s thyroiditis (37.6%); Group D included those who showed no thyroid antibodies and normal ultrasound (39.2%).
Thyroid-stimulating hormone was higher in groups A and C than in groups B and D and controls (P<.05), according to the researchers. Mean free thyroxine was lower in group B than in controls, and free triiodothyronine was higher in group C than in controls (P<.05).
“TSH and BMI scores were significantly correlated in group C … and TSH was also significantly associated with the degree of thyroid structure alterations,” the researchers wrote.
J Clin Endocrinol Metab. 2008;93:4749-4754.
The study by Radetti et al raises the intriguing hypothesis that obesity in childhood may lead to thyroiditis, which may manifest itself biochemically, serologically or anatomically on ultrasound, perhaps via a mechanism of 'a low grade-inflammation state' accompanying obesity. However, it is not clear from this study if the ultrasound abnormalities they documented truly reflect thyroiditis. Fine needle aspirations done on 12 of 70 consecutive patients with ultrasound abnormalities without antithyroid antibodies did not demonstrate thyroiditis, while other reports indicate that the ultrasound abnormalities of chronic thyroiditis generally precede antibody positivity. In any event, these findings, if confirmed and followed prospectively may provide insight into why others have observed relatively high TSH values in overweight and obese populations and whether subtle shifts in thyroid hormone economy is the result of or a contributor to obesity.
– Jeffrey Garber, MD
Endocrine Today Editorial Board member