Sharma Lokesh Kumar, Sharma Neera, Kulshreshtha Bindu Amarjeet, Bansal Rahul, Aggarwal Anshita, Dutta Deep
Department of Biochemistry, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia (RML) Hospital, New Delhi, India.
Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr RML Hospital, New Delhi, India.
Eur Endocrinol. 2020 Oct;16(2):161-166. doi: 10.17925/EE.2020.16.2.161. Epub 2020 Oct 6.
The impact of altered cholesterol metabolism on post-prandial lipids in Indians with hypothyroidism is not known. This study evaluated the impact of overt primary hypothyroidism (OPH) and subclinical hypothyroidism (ScH) on post-prandial lipids after a standardised, carbohydrate-rich, mixed meal.
Endocrinology outpatients were screened for possible inclusion into the study. Patients >18 years of age with hypothyroidism who were not taking levothyroxine and who did not present with any comorbidities underwent biochemical evaluation following a carbohydrate-rich, mixed meal. Assessments included total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, lipoprotein-A (Lp-A), apolipoprotein-A1 (apo-A1), apolipoprotein-B (apo-B), insulin and fasting glucose. Assessments were carried out 1 hour, 2 hours and 4 hours after the meal. Patients were compared against healthy matched controls recruited from healthcare professionals in the hospital (asymptomatic and apparently healthy nursing staff, reception staff and ward staff).
Data from 194 patients (161 with ScH and 33 with OPH) and 40 euthyroid controls were analysed. Anthropometry, body mass index, glycaemia and insulin resistance were comparable among patients with OPH and ScH, and controls. LDL-C and Lp-A were significantly higher in those with OPH, compared with ScH and controls, at baseline, 1 hour, 2 hours and 4 hours after mixed meal consumption (all p<0.05). There was progressive and similar decline in post-prandial TC, LDL-C and Lp-A in all three groups. Triglycerides were similar among the OPH, ScH and control groups, both in fasting and post-prandial state, with a progressive and similar increase in post-prandial triglycerides in all three groups.
This study demonstrated that severity of hypothyroidism had no impact on post-prandial TC, LDL-C and Lp-A. In addition, hypothyroidism had no impact on post-prandial triglycerides. Therefore, we conclude that lipid profile can be reliably estimated in a non-fasting state in individuals with ScH and OPH.
甲状腺功能减退的印度人胆固醇代谢改变对餐后血脂的影响尚不清楚。本研究评估了显性原发性甲状腺功能减退（OPH）和亚临床甲状腺功能减退（ScH）对标准化富含碳水化合物的混合餐后餐后血脂的影响。
对内分泌门诊患者进行筛查，以确定是否可能纳入研究。年龄大于18岁、患有甲状腺功能减退且未服用左甲状腺素且无任何合并症的患者在进食富含碳水化合物的混合餐后接受生化评估。评估项目包括总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯、脂蛋白A（Lp-A）、载脂蛋白A1（apo-A1）、载脂蛋白B（apo-B）、胰岛素和空腹血糖。在餐后1小时、2小时和4小时进行评估。将患者与从医院医护人员中招募的健康匹配对照（无症状且明显健康的护理人员、接待人员和病房工作人员）进行比较。
分析了194例患者（161例ScH患者和33例OPH患者）和40例甲状腺功能正常对照的数据。OPH和ScH患者以及对照之间的人体测量学、体重指数、血糖和胰岛素抵抗具有可比性。与ScH患者和对照相比，OPH患者在混合餐食用后基线、1小时、2小时和4小时时的LDL-C和Lp-A显著更高（所有p<0.05）。三组餐后TC、LDL-C和Lp-A均呈逐渐且相似的下降。OPH、ScH和对照组的甘油三酯在空腹和餐后状态均相似，三组餐后甘油三酯均呈逐渐且相似的升高。
本研究表明，甲状腺功能减退的严重程度对餐后TC、LDL-C和Lp-A无影响。此外，甲状腺功能减退对餐后甘油三酯无影响。因此，我们得出结论，在ScH和OPH患者中，非空腹状态下的血脂水平可以可靠地估计。
