ZANCO Journal of Pure and Applied Sciences

The official scientific journal of Salahaddin University-Erbil

ZJPAS (2017), (5); 186-191
http://dx.doi.org/10.21271/ZJPAS.29.5.20

Correlation between thyroid hormones and body weight in female hypothyroids in

Erbil city

Ahmed A. Baban1, Salar Adnan Ahmed2, Baderkhan Saeed Ahmed1, Sazgar Anwar Hameed3

1- Surgery Department, College of Medicine - Hawler Medical University – Erbil -Iraq

2- Clinical Biochemistry Department, College of Medicine - Hawler Medical University – Erbil -Iraq
3- Public Health Lab- Jamhuri Teaching Hospital, Erbil- Iraq

ARTICLE INFO ABSTRACT

Article History: Hypothyroidism, also known as underactive thyroid, is a condition

Received: 21/05/2017
Accepted: 30/07/2017
Published: 28/ 12 /2017
Keywords:
Hypothyroidism
Thyroid stimulating_
hormone
T3
T4
Weight gain
*Corresponding Author:
Dr. Salar A. Ahmed
salarzrari@yahoo.com
where the thyroid gland does not produce enough of thyroid hormone thyroxine.
Thyroid hormones regulate the way in which the body uses energy - metabolism -
and without enough thyroxine, many of the body's functions slow down. Through
this study we aimed to define the relationship of fluctuations that might exist
between serum thyroid stimulating hormone, triiodothyronine and its prohormone
thyroxine with body weight in hypothyroidism. The present cross-sectional study
deals with estimation of serum thyroid stimulating hormone, triiodothyronine,
thyroxine, 25-Hydroxy vitamin D (25-OH vitamin D3) and calcium levels in (100)
patients with hypothyroidism. The mean ± SE concentrations of serum thyroid
stimulating hormone, triiodothyronine, thyroxine, 25-OH vitamin D3 and calcium
were 7.1 ± 0.9 µIU/ml, 10.6 ±1.1 nmole/L, 41.1 ±1.4 nmole/L, 29.5 ± 2.3 nmole/L
and 13.4 ± 2.1 mg/dl, respectively. In the existing study we found, a statistical
positive correlation (r = 0.404 ) between thyroid stimulating hormone and body
weight. While there were a negative correlation between triiodothyronine (r = -
0,41538 ), thyroxine (r = -0,41538 ) and body weight. Our results demonstrates that
weight gain and obesity are two common manifestation of hypothyroidism.

1. INTRODUCTION central and peripheral nervous systems, muscle

Thyroid gland is a butterfly-shaped
endocrine gland located in the base of neck. It
secretes thyroid hormones, which regulate gene
transcription and body metabolism in starved
and fed states throughout the body (Feldt-
Rasmussen, 2007; Zimmermann-Belsing,
2003). The released hormones play a key role
in the basal metabolic rate as well as vital body
functions, including: breathing, heart rate,
strength, menstrual cycles, as well as regulate
body temperature, and cholesterol levels.
(Laurberg et al,2012). However, overt thyroid
disease is associated with marked changes in
energy expenditure and body weight, with
enhanced protein breakdown and lipolysis (Riis
et al , 2002; Riis et al, 2005; Zulewski et al,
1997). Moreover, subclinical hypothyroidism
has been associated with a greater risk for both
187 Baban A. et al. /ZJPAS: 2017,29 (5): 186-191
cardiovascular morbidity and mortality in some
but not all prospective population-based studies
as well as overweight and obesity (Al-Adsani et
al, 1997).
Recently, adipose tissue has been
recognized as a major endocrine organ,
involved in the regulation of thermogenesis,
food intake, and energy expenditure, e.g., the
change between fed and starved state (Laurberg
et al,2012). Studies of weight reduction by
bariatric surgery or gastric banding.
(Chikunguwo et al (2007) and Dall'Asta et al
(2010) have found postoperative changes in
levels of thyroid stimulating hormone (TSH),
triiodothyronine (T3), and prohormons
thyroxine (T4) but in different directions.
Likewise, a decrease in TSH was observed
following diet-, exercise-, and behavior
therapy-induced weight loss in children and
adolescents (Aeberli et al, 2010; Reinehr et al,
2006; Araujo et al, 2010). The relationship
between body weight and thyroid hormones
seems conceivable and the exact mechanisms
are yet unexplained and temporality is debated.
Therefore, the aim of the present study was to
investigate the possible relationship between
serum fluctuations of the TSH, T3 and its
prohormone T4 with body weight in
hypothyroidism under thyroxin therapy.
2. MATERIALS AND METHODS
2.1. Subjects
The present study was carried out from
May 2016 to January 2017 by collaboration
between Clinical Biochemistry and Surgery
departments in College of Medicine- Hawler
Medical University-Iraq-Kurdistan region.
Anthropometric data and thyroid function
parameters were retrospectively reviewed for
100 hypothyroidism patients with the mean ±
SE age 33.6 ± 1.3 years, ranging from 21 - 62
years of age, all examined samples were
collected from patients that have been referred
to the hospital, patients were diagnosed with
hypothyroidism by a clinician and pre surgery
diagnoses included benign (Graves disease,
nodular toxic goiter, nodular nontoxic goiter)
and malignant (differentiated thyroid cancer)
conditions.
2.2. Collection of blood samples
Blood samples (5ml) were collected via
a traumatic antecubital venipuncture into
vacutainer tubes. The collected blood samples
allowed to stand at room temperature until it
has clotted, and the serum was recovered by
centrifugation at 3000 rpm for 15 minutes for
removal of any suspended cells. The samples
were used immediately for estimation of serum
thyroid hormones (TSH, T3 and T4), calcium
and 25-OH vitamin D3.
2.3. Methods
a) Estimation of serum TSH, T3 and T4
In vitro quantitative determinations of
TSH, T4 and T3 in human serum were
performed using Automated Cobas e 411
Immunoassay Analyzers based on
electrochemiluminescent technology that is the
using of ruthenium complex and the measuring
cell.
b) Estimation of 25-OH vitamin D3
Diazyme's Enzyme-Immunoassay
FemtoQuant™ 25-OH vitamin D3 test is based
on the principle of α-complementation of the
enzyme β-galactosidase and the competition
between an enzyme donor-25-OH vitamin D3
conjugate, an anti-vitamin D3 antibody and the
25-OH vitamin D3 content of a serum sample.
Samples with higher 25-OH vitamin D3
concentrations produce higher β-galactosidase
activities and vice versa. A nitrophenyl-ß-
galactoside derivative (NPG) is used as the
enzyme substrate. The reaction's product has
maximum absorbance at 415 nm. The 25-OH
vitamin D3 concentration of a sample is
188 Baban A. et al. /ZJPAS: 2017,29 (5): 186-191

proportional to the measured β-galactosidase
activity (Saida et al, 2014).
c) Estimation of calcium
Serum calcium was determined by an
enzymatic colorimetric method using readily
made kits Biomerieux Sa. (France) according
to the Coms method (Corns and Ludman,
1987).
d) Statistical analysis
Data were evaluated by SPSS software
version 19 (SPSS Inc.,Chicago, IL, USA). The
correlation coefficient (r) was used to assess
the link between TSH, T3, T4 and weight gain,
T-test for independent samples was used to
assess the difference between serum samples.
Table (1). The mean ± S.E value for serum
TSH was 7.1 ± 0.9 µIU/ml with a range of
variation 0.005 – 137 µIU/ml and the mean ±
S.E value of serum T3 & T4 were 10.6 ±1.1 &
41.1 ±1.4 nmole/L with a range of variation
0.806 – 183.5 & 2.38 – 142.5 nmole/L,
respectively.
The mean ± S.E value for serum calcium
was 13.4 ± 2.1 mg/dl and the range of variation
was 2.49 – 50 mg/dl. The mean value of 25-
OH vitamin D3 in sera of patients with
hypothyroidism was 29.5 ± 2.3 nmole/L and
the range of variation was 5.89 – 100 nmole/L.
Table 1: Details of biochemical parameters of the
studied group.

Values are reported as mean ± SE. P<0.05 was

considered statistically significant (Daniel,
1983). Parameters Mean ± SE Range
Age (years) 33.6 ± 1.3 21 - 62
Weight (kg) 66.1 ± 2.3 0.59 - 98
2.4. Ethical considerations
TSH (µIU/ml) 7.1 ± 0.9 0.005 - 137
The study was approved by the research
T3 nmole/L 10.6 ±1.1 0.806 - 183.5
Ethical Committee of Hawler Medical
T4 nmole/L 41.1 ±1.4 2.38 - 142.5
University/ College of Medicine-Erbil. An
Calcium mg/dl 13.4 ± 2.1 2.49 - 50
informed and written consent was taken from
25-OH vitamin
each participant before samples collection. D3 nmole/L 29.5 ± 2.3 5.89 - 100

3. RESULTS Figures (1, 2 & 3) shows the correlation

3.1. Characteristics of the study
population
This retrospectives study was carried out
on 100 women with hypothyroidism
(Underactive Thyroid hormone). The mean ±
SE age was 33.6 ± 1.3 with a range of
variation 21 to 62 years while the mean ± SE
weight 66.1 ± 2.3 Kg with a range of variation
59 - 98 Kg.
coefficient between serum TSH, T3, T4 and
body weight. According to our data, a
statistical positive correlation (r2 = 0.2347 & r
= 0.484 ) was observed between TSH and body
weight. While there were a negative correlation
between T3 (r2 = 0.1725 & r= -0,415), T4 (r2 =
0.17 & r = -0,41 ) and body weight.

3.2. Results of biochemical parameters

Details of biochemical parameters of
the studied group (hypothyroidism patients) are
given in Table 1. The laboratory parameters of
patients with hypothyroidism are shown in
189 Baban A. et al. /ZJPAS: 2017,29 (5): 186-191

25 4. DISCUSSION
y = 0.2491x - 14.06 To investigate any possible relationship
20 R² = 0.2347
between serum TSH, T3, T4 and body weight
15 in Kurdistan region we assayed a series of
TSH  IU/ml

serum samples of clinically diagnosed patients

10 with hypothyroidism under thyroxin therapy.
5
Obesity is increasingly being identified as a
major epidemic today raising worldwide health
0 concerns (Solanki et al, 2013; Asvold et al,
50 70 90 110 2009), although the increase in the prevalence
-5
Body Weight (kg) of obesity seems to have stopped in some
countries according to recent investigations
Figure 1: Correlation coefficient between Thyroid-
(Svendstrup et al, 2011). The international
stimulating hormone and body weight.
focus on obesity has led to a steep increase in
the number of studies dealing with possible
16
interactions between obesity and other diseases
Triiodothyronine (T3) nmole/L

y = -0.2686x + 26.585
14
R² = 0.1725 as well as the relation between obesity and
12
physiology and pathophysiology of the various
10
organs and tissues of the body (Laurberg et
8
al,2012).
6
Our study clearly showed that any
4
changes in the level of serum TSH, T3, T4
2
appears to be associated with weight loss,
0
55 65 75 85 weight gain and obesity.
Body Weight (Kg)
The current study found a positive
correlation between TSH and body weight
Figure 2: Correlation coefficient between serum while T3 and T4 inversely proportional with
Triiodothyronine (T3) and body weight the body weight. These finding were in
accordance with the other investigators
(Solanki et al, 2013; Gupta et al, 2015;
25 Milionis and Milionis, 2013; Seo et al, 2016;
y = -0.276x + 32.527
Rotondi et al, 2014).
Thyroxine (T4) nmole/L

20 R² = 0.171
Thyroid hormone (TH) regulates
15 metabolic processes essential for normal
growth and development as well as regulating
10
metabolism (Brent, 2012 a).
5 The causal relationship between body
weight and variations in thyroid function could
0 be explained by the process of thermogenesis
57 67 77 87
increase thermogenesis through an increase in
Body Weight (Kg)
cellular activity to produce ATP (Milionis and
Figure 3: Correlation coefficient between serum Milionis, 2013).
thyroxine (T4) and body weight Reduced thyroid hormone levels
(Hypothyroidism) is associated with
190 Baban A. et al. /ZJPAS: 2017,29 (5): 186-191
hypometabolism characterized by reduced
resting energy expenditure, weight gain,
increased cholesterol levels, reduced lipolysis,
and reduced gluconeogenesis (Brent, 2012 b).
TH stimulates both lipogenesis and lipolysis,
although when TH levels are elevated, the net
effect is fat loss (Oppenheimer et al, 1991). TH
influences key metabolic pathways that control
energy balance by regulating energy storage
and expenditure. TH regulates metabolism
primarily through actions in the brain, white
fat, brown fat, skeletal muscle, liver, and
pancreas (Mullur et al, 2014).
5. CONCLUSIONS
a) In our findings it can be concluded that
any change in the level of serum TSH,
T3, T4 can be correlated with gain or
lose of body weight.
b) This study revealed that there is a
statistical positive correlation between
TSH and body weight while the
correlation were negative between T3,
T4 and body weight.
c) Further multicentric and large studies
are required for a general assumption
of the correlation between obesity and
variations of normal thyroid function
with more focused approach on the
mechanistic aspects.
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