Background/Aims: The aim of this study was to analyze thyroid hormones in female adolescents with obesity and anorexia nervosa (AN) before and after normalization of weight. Methods: Thyroid-stimulating hormone (TSH), fT3, and fT4 were determined in 100 obese girls, 32 normal-weight girls and 20 girls with AN aged 14–18 years at baseline and 1 year later. Additionally, leptin, insulin, and the insulin resistance index HOMA were analyzed in the obese and normal-weight girls. Results: TSH and fT3 levels of girls with AN were significantly lower compared to TSH concentrations of normal-weight girls, while TSH and fT3 levels of the obese girls were significantly higher. The 21 obese females with weight loss >5% demonstrated a significant decrease in fT3 and TSH, while the 9 adolescents with AN and weight gain >5% showed a significant increase in fT3 and TSH. Insulin and HOMA were not significantly correlated to TSH, fT3 and fT4, while leptin was correlated to TSH and fT3 in both cross-sectional and longitudinal analysis. Conclusions: Thyroid function seems to be reversibly related to weight status with increased TSH and fT3 concentrations in obesity and decreased TSH and fT3 levels in AN. We hypothesize that leptin may be the link between weight status and TSH.

Keywords:
Obesity, Thyroid-stimulating hormone, Weight loss, Anorexia nervosa, Weight gain
1.
Haas V, Onur S, Paul T, Nutzinger DO, Bosy-Westphal A, Hauer M, Brabant G, Klein H, Muller MJ: Leptin and body weight regulation in patients with anorexia nervosa before and during weight recovery. Am J Clin Nutr 2005;81:889–896.
2.
Onur S, Haas V, Bosy-Westphal A, Hauer M, Paul T, Nutzinger D, Klein H, Muller MJ: L-tri-iodothyronine is a major determinant of resting energy expenditure in underweight patients with anorexia nervosa and during weight gain. Eur J Endocrinol 2005;152:179–184.
3.
Van Wymelbeke V, Brondel L, Marcel Brun J, Rigaud D: Factors associated with the increase in resting energy expenditure during refeeding in malnourished anorexia nervosa patients. Am J Clin Nutr 2004;80:1469–1477.
4.
Kiyohara K, Tamai H, Takaichi Y, Nakagawa T, Kumagai LF: Decreased thyroidal triiodothyronine secretion in patients with anorexia nervosa: influence of weight recovery. Am J Clin Nutr 1989;50:767–772.
5.
Misra M, Miller KK, Kuo K, Griffin K, Stewart V, Hunter E, Herzog DB, Klibanski A: Secretory dynamics of leptin in adolescent girls with anorexia nervosa and healthy adolescents. Am J Physiol Endocrinol Metab 2005;289:E373–E381.
6.
Stichel H, l’Allemand D, Gruters A: Thyroid function and obesity in children and adolescents. Horm Res 2000;54:14–19.
7.
Kiortis DN, Durack I, Turpin G: Effects of a low-calorie diet on resting metabolic rate and serum triiodothyronine levels in obese children. Eur J Pediatr 1999;158:446–450.
8.
Reinehr T, de Sousa G, Andler W: Hyperthyrotropinemia in obese children is reversible after weight loss and is not related to lipids. J Clin Endocrinol Metab 2006;91:3088–3091.
9.
Reinehr T, Andler W: Thyroid hormones before and after weight loss in obesity. Arch Dis Child 2002;87:320–323.
10.
Nyrnes A, Jorde R, Sundsfjord J: Serum TSH is positively associated with BMI. Int J Obes (Lond) 2006;30:100–105.
11.
Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H, Ovesen L, Jorgensen T: Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 2005;90:4019–4024.
12.
Sari R, Balci MK, Altunbas H, Karayalcin U: The effect of body weight and weight loss on thyroid volume and function in obese women. Clin Endocrinol (Oxf) 2003;59:258–262.
13.
Rosenbaum M, Hirsch J, Murphy E, Leibel RL: Effects of changes in body weight on carbohydrate metabolism, catecholamine excretion, and thyroid function. Am J Clin Nutr 2000;71:1421–1432.
14.
Tagliaferri M, Berselli ME, Calo G, Minocci A, Savia G, Petroni ML, Viberti GC, Liuzzi A: Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile. Obes Res 2001;9:196–201.
15.
Danforth E, Burger AG: The role of thyroid hormones in the control of energy expenditure. Clin Endocrinol Metab 1984;13:581–595.
16.
Leslie RD, Isaacs AJ, Gomez J, Raggat PR, Bayliss R: Hypothalamo-pituitary-thyroid function in anorexia nervosa: infl‚uence of weight gain. BMJ 1978;2:526–528.
17.
Munoz MT, Argente J: Anorexia nervosa in female adolescents: endocrine and bone mineral density disturbances. Eur J Endocrinol 2002;147:275–286.
18.
Chuub SAP, Davis WA, Davis TME: Interactions between thyroid function, insulin sensitivity and serum lipid concentrations: The Fremantle Diabetes Study. J Clin Endocrinol Metab 2005;88:2714–2718.
19.
Ortiga-Carvalho TM, Oliveira KJ, Soares BA, Pazos-Moura CC: The role of leptin in the regulation of TSH secretion in the fed state: in vivo and in vitro studies. J Endocrinol 2002;174:121–125.
20.
Cole TJ, Bellizzi MC, Flegal KM, Dietz WH: Establishing a standard definition for child overweight and obesity world-wide: international survey. BMJ 2000;320:1240–1243.
21.
Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiss HC, Hesse V, Remer T, Schaefer F, Wittchen HU, Zabransky S, Zellner K, Hebebrand J: Percentiles of body mass index in children and adolescents evaluated from different regional German studies. Monatsschr Kinderheilkd 2001;149:807–818.
22.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
23.
Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985;28:412–419.
24.
Reinehr T, de Sousa G, Toschke M, Andler W: Long-term follow-up of cardiovascular risk factors in obese children after intervention. Am J Clin Nutr 2006;84:490–496.
25.
Reinehr T, Kersting M, Wollenhaupt A, Alexy U, Kling B, Ströbele K, Andler W: Evaluation of the Training Program ‘OBELDICKS’ for Obese Children and Adolescents. Klin Päd 2005;217:1–8.
26.
Wimpfheimer K, Saville E, Voirol MJ, Danforth E, Burger AG: Starvation-induced decreased sensitivity of resting energy rate to triiodothyronine. Science 1979;205:1272–1273.
27.
Gardner DF, Kaplan MM, Stanley CA, Utiger RD: Effect of triiodothyronine replacement on the metabolic and pituitary responses to starvation. N Engl J Med 1979;300:579–584.
28.
Smorawinska A, Korman E, Rajewski A: Disturbances of the thyroid function in patients with anorexia nervosa. Endokrynol Diabetol Chor Przemiany Materii Wieku Rozw 2001;7:81–84.
29.
Havel PJ, Kasim-Karakas S, Mueller W, Johnson PR, Gingerich RL, Stern JS: Relationship of plasma leptin to plasma insulin and adiposity in normal and overweight women. Effects of dietary fat content and sustained weight loss. J Clin Endocrinol Metab 1996;81:4406–4413.
30.
Hebebrand J, Blum WF, Barth N: Leptin levels in patients with anorexia nervosa are reduced in the acute stage and elevated upon short-term weight restoration. Mol Psychiatry 1997;2:330–334.
31.
Reinehr T, Kratzsch J, Kiess W, Andler A: Circulating soluble leptin receptor, leptin, and insulin resistance before and after weight loss in obese children. Int J Obes 2005;29:1230–1235.
32.
Mantzoros CS, Ozata M, Negrao AB, Suchard MA, Ziotopoulou M, Caglayan S, Elashoff RM, Cogswell RJ, Negro P, Liberty V, Wong ML, Veldhuis J, Ozdemir IC, Gold PW, Flier JS, Licinio J: Synchronicity of frequently sampled thyrotropin (TSH) and leptin concentrations in healthy adults and leptin-deficient subjects: evidence for possible partial TSH regulation by leptin in humans. J Clin Endocrinol Metab 2001;86:3284–3291.
33.
Kok P, Roelfsema F, Langendonk JG, Frolich M, Burggraaf J, Meinders AE, Pijl H: High circulating thyrotropin levels in obese women are reduced after body weight loss induced by caloric restriction. J Clin Endocrinol Metab 2005;90:4659–4663.
34.
Danforth E, Horton ES, O‘Connel M, Sims EAH, Burger AG, Ingbar SH, Braverman L, Vagenakis AG: Dietary-induced alterations in thyroid hormone metabolism during overnutrition. J Clin Invest 1979;64:1336–1347.
35.
Chomard P, Vernhes G, Autissier N, Debry G: Serum concentrations of total and free thyroid hormones in moderately obese women during a six-week slimming cure. Eur J Clin Nutr 1997;42:285–293.
36.
Spaulding SW, Chopra IJ, Sherwin RS, Lyall SS: Effect of caloric restriction on serum T3 and reverse T3 in man. J Clin Endocrinol Metab 1976;42:197–200.
37.
O’Brian JT, Bybee DE, Burman KD, Osburne RC, Ksiazec MR, Wartofsky L, George P: Thyroid hormone homeostasis in states of relative caloric deprivation. Metabolism 1980;29:566–573.
38.
Pauly R, Lear SA, Hastings FC, Birmingham CL: Resting energy expenditure and plasma leptin levels in anorexia nervosa during acute refeeding. Int J Eat Disord 2000;28:231–234.
39.
Santini F, Pinchera A, Marsili A, Ceccarini G, Castagna MG, Valeriano R, Giannetti M, Taddei D, Centoni R, Scartabelli G, Rago T, Mammoli C, Elisei R, Vitti P: Lean body mass is a major determinant of levothyroxine dosage in the treatment of thyroid diseases. J Clin Endocrinol Metab 2005;90:124–127.
40.
Wallace TM, Matthews DR: The assessment of insulin resistance in man. Diabet Med 2002;19:527–534.
41.
Uwaifo GI, Fallon EM, Chin J, et al: Indices of insulin action, disposal, and secretion derived from fasting samples and clamps in normal glucose-tolerant black and white children. Diabetes Care 2002;25:2081–2087.
© 2008 S. Karger AG, Basel
2008
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.