Muhammad Shahzad Saleem, Tanvir Ali Khan Shirwany, Khurshid Ahmad Khan


Background: Metabolic Syndrome is a group of factors that predispose to cardiovascular diseases.
The prevalence of metabolic syndrome is rising rapidly. Recently, a few studies have suggested that
lower thyroid function in the reference range may be associated with metabolic syndrome, but the
issue remains unsettled. We aimed to elucidate the relationship between thyroid function and
components of metabolic syndrome in a sample of euthyroid Pakistani population. Methods: This
analytical, cross-sectional study was conducted at the Department of Physiology, University of
Health Sciences, Lahore, Pakistan, and extended over a period of 12 months. It included 100 subjects
with metabolic syndrome in the study group and thirty subjects without metabolic syndrome in the
control group with age ranging 45–55 years. Both groups had normal thyroid function. After a
detailed history and clinical examination, fasting blood was analysed for glucose, triglycerides, high
density lipoprotein-cholesterol along with thyroid-stimulating hormone (TSH) and free thyroxine.
Results: Serum TSH was significantly higher in study group than in control group (p=0.040). Serum
free thyroxine values of study group were slightly but not significantly lower than those of control
group. Serum TSH correlated significantly and positively with serum triglycerides in all subjects and
with waist circumference and diastolic blood pressure in men. Serum TSH showed a positive and
linear relationship with the number of components of metabolic syndrome (p=0.016) in all subjects.
Conclusion: High-normal TSH is associated with metabolic syndrome and its components. There
may be increased risk of cardiovascular diseases with high-normal TSH levels.
Keywords: Thyroid Stimulating Hormone, Metabolic Syndrome, Euthyroid

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Dysmetabolic syndrome X; Metabolic syndrome; code 277.7;

[cited 27th July 2009] Available from:

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel HR,

Franklin BA et al. Diagnosis and management of the metabolic

syndrome: an American heart association/ national heart, lung and

blood institute scientific statement: executive summary. Circ


Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb

Vasc Biol 2008;28:629.

Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic

syndrome among US adults: findings from the third national

health and nutrition examination survey. JAMA2002;287:356–9.

Basit A, Shera AS. Prevalence of metabolic syndrome in Pakistan.

Metabolic Syndrome and Related Disorders 2008;6(3):171–5.

Surana SP, Shah DB, Gala K, Susheja S, Hoskote SS, Gill N et al.

Prevalence of metabolic syndrome in an urban Indian diabetic

population using the NCEP ATP III guidelines. Journal of

Association of Physicians of India 2008;56:865–8.

Mehboob F, Majeed MZ, Zaman SM. An impact of lifestyle and

obesity on diabetes, hypertension and hyperlipidemia. J Fatima

Jinnah Med Coll Lahore 2007;1:59–63.

Bonow RO, Eckel RH. Diet, obesity, and cardiovascular risk. N

Engl J Med 2003;348:2057–8.

Hossain P, Kawar B, El Nahas M. Obesity and diabetes in the

developing world -a growing challenge. N Engl J Med


McLaughlin T, Abbasi F, Cheal K, Chu J, Lamendola C, Reaven

G. Use of metabolic markers to identify overweight individuals

who are insulin resistant. Ann Intern Med 2003;139:802–9.

Reaven G. Metabolic syndrome: pathophysiology and implications

for management of cardiovascular disease. Circulation


Groop L. Genetics of the metabolic syndrome. British Journal of

Nutrition 2000;83, Suppl.1:S39–48.

Roche HM, Phillips C, Gibney MJ. The metabolic syndrome: the

crossroads of diet and genetics. Proceedings of the Nutrition

Society 2005;64:371–7.

Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, et

al. Cardiovascular morbidity and mortality associated with the

metabolic syndrome. Diabetes Care 2001;24:683–9.

Reddy KS. Cardiovascular disease in non-western countries. N

Eng J Med 2004;350:2438–40.

Krotkiewski M. Thyroid hormones in the pathogenesis and

treatment of obesity. European Journal of Pharmacology


Fommei E, Iervasi G. The role of thyroid hormone in blood

pressure homeostasis: evidence from short-term hypothyroidism in

humans. J Clin Endocrinol Metab 2002;87:1996–2000.

Roos A, Bakker SJL, Links TP, Gans ROB and Wolffenbuttel

BHR. Thyroid function is associated with components of the

metabolic syndrome in euthyroid subjects. J Clin Endocrinol

Metab 2007;92:491–6.

Asvold BO, Vatten LJ, Nilsen TIL, Bjoro T. The association

between TSH within the reference range and serum lipid

concentrations in a population based study, The HUNT study.

European Journal of Endocrinology 2007;156:181–6.

Knudsen N, Laurberg P, Rasmussen LB, Bulow I, Perrild H,

Ovesene L, et al. 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;90:4019–24.

Park HT, Cho GJ, Ahn KH, Shin JH, Hong SC, Kim T, et al.

Thyroid stimulating hormone is associated with metabolic

syndrome in euthyroid post menopausal women. Maturitas


Shantha GPS, Kumar AA, Jeyachandran V, Rajamanickam D,

Rajkumar K, Salim S, et al. Association between primary

hypothyroidism and metabolic syndrome and the role of C reactive

protein: a cross-sectional study from South India. Thyroid

research 2009;2:2.

Ortho Clinical Diagnostics [homepage on the internet]; Vitros®

immunodiagnostic products; FT4 and TSH reagent packs:

instructions for use [cited Jan 21, 2008]; Available from:


Fernandez-Real JM, Lopez-Bermejo A, Castro A, Casamitjana R,

Ricart W. Thyroid function is intrinsically linked to insulin

sensitivity and endothelium-dependent vasodilation in healthy

euthyroid subjects. J Clin Endocrinol Metab 2006;91:3337–43.

J Ayub Med Coll Abbottabad 2011;23(2)

Kim BJ, Kim TY, Koh JM, Kim HK, Park JY, Lee KU, et al.

Relationship between serum free T4 (FT4) levels and metabolic

syndrome (MS) and its components in healthy euthyroid subjects.

Clinical Endocrinology 2009;70:152–60.

Lin SY, Wang YY, Liu PH, Lai WA, Sheu WH-H. Lower serum

free thyroxine levels are associated with metabolic syndrome in a

Chinese population. Metabolism: clinical and experimental


Asvold BO, Bjoro T, Nilsen TIL, Gunnell D, Vatten LJ.

Thyrotropin levels and risk of fatal coronary heart disease. Arch

Intern Med 2008;168:855–60.

Goichot B, Sapin R, Schlienger JL. Subclinical hyperthyroidism:

considerations in defining the lower limit of the thyrotropin

reference interval. Clinical Chemistry 2009;55:420–4.

Al-Adsani H, Hoffer LJ, Silva JE. Resting energy expenditure is

sensitive to small dose changes in patients on chronic thyroid

hormone replacement. J Clin Endocrinol Metab 1997;82:1118–25.

Torrance CJ, Devente JE, Jones JP, Dohm GL. Effects of thyroid

hormone on GLUT 4 glucose transporter gene expression and

NIDDM in rats. Endocrinology 1997;138:1204–14.

Boelen A, Schiphorst MCP-T, Wiersinga WM. Soluble cytokine

receptors and the low 3,5,3'-triiodothyronine syndrome in patients

with non-thyroidal disease. J Clin Endocrinol Metab 1995;80:971–6.

Asvold BO, Bjoro T, Nilsen TIL, Vatten LJ. Tobacco smoking and

thyroid function. Arch Intern Med 2007;167:1428–32.

Sari R, Balci MK, Altunbas H, Karayalcin U. The effect of body

weight and weight loss on thyroid volume and function in obese

women. Clinical Endocrinology 2003;59:258–62.

Brent GA. The molecular basis of thyroid hormone action. N Eng

J Med 1994;331:847–53.

Kim SR, Talbott EA, Tull E, Vogt M, Andersen S, Kuller LH.

Contribution of abnormalities of thyroid hormones to type 2

diabetes. Diabetes Care 2000;23:260–1.


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