title: Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile.
abstract: OBJECTIVE
  To evaluate whether subclinical hypothyroidism (SH) affects resting energy expenditure (REE) as well as body composition, lipid profile, and serum leptin in obese patients.
  
  
  METHODS
  A total of 108 obese patients with SH defined as normal free thyroxine levels and thyroid-stimulating hormone (TSH) values of > 4.38 microU/ml (mean +/- 2 SD of the values of our reference group of obese patients with normal thyroid function) were compared with a group of 131 obese patients matched for age, sex, and body mass index (BMI) but with normal TSH levels. We assessed estimated daily caloric intake by 7-day recall, REE by indirect calorimetry, body composition by bioelectrical impedance analysis, serum leptin by radioimmunoassay, and lipid profile (i.e., total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides).
  
  
  RESULTS
  All of the variables measured were not different between the euthyroid obese patients and those with SH. In a multiple regression model with REE expressed for kilograms of fat free mass (REE/kgFFM) as a dependent variable and percentage of fat mass, BMI, waist-to-hip ratio, age, TSH, free thyroxine, serum leptin, and caloric intake as independent variables, only percentage of fat mass was significantly correlated with REE/kgFFM in both groups. In the SH group only, BMI, waist-to-hip ratio, age, and TSH were related to REE/kgFFM and explained 69.5% of its variability. After dividing the patients with SH using a cutoff TSH value of 5.7 microU/ml, which represents 3 SD above the mean of TSH levels of the group of obese patients with normal thyroid function, only REE/kgFFM was significantly different and lower in the group of more severely hypothyroid patients.
  
  
  CONCLUSIONS
  In patients with obesity, SH affects energy expenditure only when TSH is clearly above the normal range; it does not change body composition and lipid profile. We suggest that, at least in obese patients, evaluation of TSH levels may be useful to rule out a possible impairment of resting energy expenditure due to a reduced peripheral effect of thyroid hormones.
authors.affiliation: Division of Endocrinology and Metabolic Diseases, Instituto di Ricovero e Cura a Carattere Scientifico, Istituto Auxologico Italiano, Verbania, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Tagliaferri
authors.forename: M E
authors.initials: ME
authors.lastname: Berselli
authors.forename: G
authors.initials: G
authors.lastname: Calò
authors.forename: A
authors.initials: A
authors.lastname: Minocci
authors.forename: G
authors.initials: G
authors.lastname: Savia
authors.forename: M L
authors.initials: ML
authors.lastname: Petroni
authors.forename: G C
authors.initials: GC
authors.lastname: Viberti
authors.forename: A
authors.initials: A
authors.lastname: Liuzzi
mesh_terms: D001481:Basal Metabolism; D001823:Body Composition; D002153:Calorimetry, Indirect; D016022:Case-Control Studies; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D020738:Leptin / Q000097:blood*; D008055:Lipids / Q000097:blood*; D008297:Male; D011939:Mental Recall; D008875:Middle Aged; D009765:Obesity / Q000097:blood / Q000150:complications / Q000209:etiology*; D011863:Radioimmunoassay; D013972:Thyrotropin / Q000097:blood
chemical_list: D020738:Leptin; D008055:Lipids; D013972:Thyrotropin