Elevated serum TSH concentrations are associated with higher BMI Z-scores in southern Iranian children and adolescents
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RESEARCH
Open Access
Elevated serum TSH concentrations are associated with higher BMI Z-scores in southern Iranian children and adolescents Ashkan Habib1, Mohadeseh Molayemat1 and Asadollah Habib2*
Abstract Background: Subclinical hypothyroidism is defined as elevated TSH levels while T4 or FT4 levels are normal. Elevated TSH levels are linked with obesity in adults. In a recent meta-analysis in Iran, 6.1% of children below 18 had obesity. Due to the low number of studies on the subject in children we, designed the study to assess the relation between BMI Z-score and TSH levels in children and adolescence. Method: This cross-sectional study was performed in a pediatric endocrinology clinic in Shiraz. Children aged between 2 to 18 years that came to the clinic for routine growth assessment follow up from January till April 2018 were considered. 850 children including 365 boys and 485 girls were included. Results: Prevalence of subclinical hypothyroidism is increased in higher BMI groups. 9.9, 13.8, 17.2 and 20.5% of underweight, healthy weight, overweight and obese had subclinical hypothyroidism respectively. Obese and overweight participants had higher odds of subclinical hypothyroidism than those who were not (OR:1.649, P = 0.010, CI95% 1.126–2.413). On the other hand, Subclinical hypothyroid participants had higher odds of overweight or obesity than those who were euthyroid (OR:1.650, P = 0.010, CI95% 1.128–2.413). When TSH is set as a dependent value, TSH level is increased (β = 0.126, r = 0.125, P = 0.001) with an increase in BMI Z-score. When BMI Z-score is set as a dependent value, BMI Z-score is increased (β = 0.113, r = 0.243, P = 0.001) with an increase in TSH level. Conclusion: BMI Z-score and elevated TSH levels are positively correlated however studies should be performed on establishing the causality. Keywords: BMI, BMI Z-score, Children, Thyroid, Hypothyroidism, Iran
Introduction Subclinical hypothyroidism is defined as elevated TSH levels while T4 or FT4 levels are normal [1]. It is a common disorder with a prevalence of 1 to 10% in Adult Community, [2, 3] while in the pediatrics population subclinical hypothyroidism is slightly lower than 2% [2, 4]. In adults, subclinical hypothyroidism is linked with abnormal lipid profiles, early signs of impaired cognitive * Correspondence: [email protected] 2 Department of Endocrinology, School of Medicine, Kazerun Branch, Islamic Azad University., First Floor, Zafar Building, Zand St, PO Box: 71384-37984, Shiraz, Iran Full list of author information is available at the end of the article
function and increased risk of progression into overt hypothyroidism [2, 3, 5–8]. Elevated TSH levels are linked with obesity [9], and they are found to be reversible after weight loss, whether being attained through bariatric surgery or diet [10–15]. These changes are also found to be a consequence of obesity not the cause of it [12, 13, 16]. Similar mechanisms have been hypothesized to explain this elevated TSH levels in the obese population, including an adaptation to
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