Alterations in levels of intermediate-chained acylcarnitines associate with weight-gain following reestablishment of eut
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RESEARCH LETTER
Alterations in levels of intermediate-chained acylcarnitines associate with weight-gain following reestablishment of euthyroidism in Graves’ disease Mahmoud Al Majdoub1 Mikael Lantz1,2 Peter Spégel1,3 ●
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Received: 15 May 2018 / Accepted: 23 August 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018
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Introduction Graves’ disease (GD) is an autoimmune disease resulting in increased production of thyroid hormones. The disease is associated with a state of relative starvation that, despite of increased hunger and food intake, result in weight loss and muscle weakness [1]. Fatty acid oxidation is increased due to a reduced sensitivity of carnitine palmitoyl transferase 1 (CPT1), a master regulator of lipid metabolism, to inhibition by malonyl-CoA [2, 3]. Moreover, increased expression and activity of this protein has been suggested in the disease [2, 3]. Hence, the disease is likely to result in exaggerated production of acylcarnitines, resulting in release of these intermediates into the circulation [4]. In line with this, two recent studies have shown a marked reduction in acylcarnitine levels, particularly of those with intermediate chain length, following reinstatement of euthyroidism in GD [5, 6]. GD is treated by anti-thyroid medication, radioiodine or surgery and depending on treatment modality may be followed by thyroid hormone replacement therapy [7]. Treatment may result in excessive weight gain, which is a major concern of the patient [8]. Hence, identification of those at
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12020-018-1735-9) contains supplementary material, which is available to authorized users. * Peter Spégel [email protected] 1
Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
2
Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
3
Department of Chemistry, Centre for Analysis and Synthesis, Lund University, Lund, Sweden
high risk for excessive weight gain could identify patients requiring supplementary life-style interventions. Attempts have been made to predict weight regain using anthropometric and clinical features [9]. Weight changes prior to diagnosis, treatment, and length of follow up were found to be the most significant risk factors associated with weight gain [9]. Here, we examine if low baseline levels of intermediate-chained acylcarnitines is a risk factor for excessive weight gain in Swedish patients with GD. We also examine whether changes in acylcarnitine levels associate with weight gain following reinstatement of euthyroidism.
Subjects and methods Data on levels of nine intermediate-chained acylcarnitines, anthropometric and clinical data were collected from a previously published study [6]. Nineteen patients were initially included. One patient was excluded due to lack of BMI data. All patients were treated with methimazole 15 mg twice daily and substituted with L-thyroxine to reestablish euthyroidism (
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