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CMRP 311 No. of Pages 5

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Contents lists available at ScienceDirect

Current Medicine Research and Practice

journal homepage: www.elsevier.com/locate/cmrp

Original article

Study of thyroid dysfunction in metabolic syndrome and association

with its components
Manoj Saluja* , Pavankumar Pyarsabadi, Shivcharan Jelia, Saurabh Chittora,
Yogesh Swami, Hemant Vimlani
Department of Medicine; Government Medical College, Kota, Rajasthan, India

A R T I C L E I N F O A B S T R A C T

Article history: Background: Metabolic syndrome is a constellation of metabolic derangements such as obesity, insulin
Received 9 April 2017 resistance, hyperinsulinemia, impaired glucose tolerance, dyslipidemia, hypertension, and a proin-
Accepted 30 November 2017 flammatory and prothrombotic state. Thyroid dysfunction is common among metabolic syndrome
Available online xxx
patients. This study investigates association of thyroid dysfunction with components of metabolic
syndrome with an aim to establish link between both entities.
Keywords: Objectives: To study the spectrum of thyroid dysfunction in patients with metabolic syndrome and to
Subclinical hypothyroidism (SCH)
evaluate the association of thyroid dysfunction with components of metabolic syndrome.
Thyroid dysfunction
Metabolic syndrome
Methodology: In this prospective case control study, thyroid profile was estimated in 100 metabolic
Waist circumference syndrome patients as well as 100 age/sex matched control population attending OPD and various wards
of New Hospital Medical College Kota, over a period of one year.
Results: In the 100 metabolic syndrome patients included in this study 37% had subclinical
hypothyroidism (SCH), 12% had overt hypothyroidism and 2% had overt hyperthyroidism. In control
group 8% had SCH and 4% had overt hypothyroidism. Thyroid dysfunction was significantly associated
(P = 0.025) with high waist circumference in patients with metabolic syndrome.
Conclusion: Thyroid dysfunction particularly subclinical hypothyroidism is a common endocrine
abnormality associated with metabolic syndrome patients, more so in female population and elderly and
is associated with one component of metabolic syndrome (waist circumference). Hence, thyroid function
tests may be included as a routine investigation in all metabolic syndrome patients.
© 2017 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.

1. Introduction Thyroid hormone plays an important role on various aspects of

The concept of interrelated metabolic disturbances was first
introduced years ago as a constellation of hypertension, hypergly-
cemia, and gout. In the year 1988 it was proposed that insulin
resistance and its compensatory hyperinsulinemia predisposed
individuals to hypertension, dyslipidemia (high plasma triglycer-
ides level and low levels of high-density lipoproteins) and diabetes
thus being the underlying cause of cardiovascular disease risk.1 The
worldwide prevalence of metabolic syndrome was found to be
between 10% and 84% depending on the ethnicity, age, gender and
race of the population2 whereas the IDF estimates that one-quarter
of the world's population has metabolic syndrome. In various
studies in India about 25–35% adults have metabolic syndrome.3,4
* Corresponding author at: C-236, Opposite Emmanual School, Talwandi, Kota,
India.
E-mail address: pavankumarp145@gmail.com (M. Saluja).
metabolism, development and differentiation of the cells.5 Thyroid
disease constitutes the most common endocrine abnormality in
the recent years, diagnosed either in subclinical or clinical form in
patients with metabolic syndrome.6 Thyroid dysfunction is defined
as the alteration in serum TSH level with normal or altered thyroid
hormones (T3, T4).
About 300 million people in the world are affected from thyroid
dysfunction and over half are presumed to be unaware of their
condition. It has been estimated that about 42 million of people in
India suffer from thyroid disease.7 Thyroid function affects the
parameters causing metabolic syndrome including low density
lipoproteins, triglycerides, blood pressure and plasma glucose. The
prevalence of thyroid dysfunction was reportedly more among
women with metabolic syndrome.8,9 Metabolic syndrome and
thyroid dysfunction are independent risk factors for cardiovascular
disease risk and mortality associated with it, it is possible that
patients suffering from both these disease may have a com-
pounded risk.10,11

https://doi.org/10.1016/j.cmrp.2017.11.010
2352-0817/© 2017 Sir Ganga Ram Hospital. Published by Elsevier, a division of RELX India, Pvt. Ltd. All rights reserved.

Please cite this article in press as: M. Saluja, et al., Study of thyroid dysfunction in metabolic syndrome and association with its components,
Curr Med Res Pract. (2017), https://doi.org/10.1016/j.cmrp.2017.11.010
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2 M. Saluja et al. / Current Medicine Research and Practice xxx (2017) xxx–xxx

Fig. 1. Age composition of study subjects.

The present study was done to understand the overall 4. Raised blood pressure 130/85 mm of Hg or any medication.
prevalence of thyroid dysfunction in metabolic syndrome patients 5. Raised fasting glucose 100 mg/dl or previously diagnosed type
in Rajasthan with the objective of early correction of thyroid 2 diabetes mellitus.
dysfunction, thus preventing complications of metabolic syn-
drome.
2.2. Exclusion criteria
2. Methodology
1. Patients with known thyroid dysfunction.
2. Any medications that alter or modify thyroid profile like
This was a prospective case control study. 100 patients with
estrogen, corticosteroids, iodine containing drugs.
metabolic syndrome as well as 100 age/sex matched controls
3. Severely ill patients.
attending the medical OPD or admitted in various wards of new
4. Pregnant women.
hospital medical college, Kota were included in the study. Serum
TSH and free t4 levels were measured by electrochemiluminescene
immunoassay using cobas auto-analyzer in all patients.
2.3. Ethical aspects

2.1. Inclusion criteria
Patients with metabolic syndrome are diagnosed based on the
criteria by the joint statement committee [International Diabetes
Federation (IDF) task force on Epidemiology and Prevention,
National Heart, Lung and Blood Institute (NHLBI), the American
Heart Association, the World Heart Federation, the International
Atherosclerosis Society, and the International Association for the
Study of Obesity]. The patients having at least three components of
joint statement definition of metabolic syndrome are included in
the study.
1. Waist circumference >90 cm for men and >80 cm for women.
2. Raised triglyceride level 150 mg/dl or any specific treatment.
3. HDL cholesterol levels <40 mg/dl in males, <50 mg/dl in
females or any specific treatment.
The study was approved by the ethical committee of our
institution. Written informed consent was obtained from all study
subjects after explaining all the features of the study.
A detailed history including physical examination was done in
all patients diagnosed of metabolic syndrome. Routine blood
investigations were done including fasting levels of lipid profile,
blood glucose and thyroid profile by standard laboratory techni-
ques using single window approach. The patients with thyroid
dysfunction are categorized according to the standard reference
range.
3. Results
A prospective case-control study of 200 patients admitted and
attending medical OPD from December 2015 to November 2016
was done. We included 100 cases and 100 controls. The mean age

Table 1
Metabolic syndrome components in male/female (study group).

Metabolic syndrome components Male Female Total 100% Mean SD

No. % No. %
Waist circumference 37 52.11 34 47.88 71 92.04  13.21
Blood pressure 27 32.14 57 67.85 84 140.02  16.29
87.02  9.65
Fasting blood glucose 37 45.12 45 54.87 82 136.18  52.50
Triglycerides 32 45.71 38 54.28 70 199.38  106.12
HDL cholesterol 29 41.42 41 58.57 70 40.76  18.93

HDL – high density lipoproteins, SD – standard deviation.

Please cite this article in press as: M. Saluja, et al., Study of thyroid dysfunction in metabolic syndrome and association with its components,
Curr Med Res Pract. (2017), https://doi.org/10.1016/j.cmrp.2017.11.010
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Table 2 3.2. Association of each component of metabolic syndrome with

Thyroid dysfunction distribution in metabolic syndrome in females and males. thyroid dysfunction
Thyroid status Females Males Total
Each component of metabolic syndrome was studied separately
Euthyroid 23 (42.6) 26 (56.5) 49
Overt hypothyroid 06 (11.1) 06 (13.1) 12
and the relation of components with occurrence of thyroid
Overt hyperthyroid 02 (3.7) 00 (0.0) 02 dysfunction in both male and female study subjects was plotted
SCH 23 (42.6) 14 (30.4) 37 down as shown in Table 3. Among all the components of metabolic
syndrome, the prevalence of thyroid dysfunction in cases with
Total 54 (100.0) 46 (100.0) 100 (100.0)
waist circumference above reference range was statistically
SCH – subclinical hypothyroidism. significant (P value = 0.025).

distribution of cases was 52.6  14.4 and that of controls was
52.8  13.94. Most of the patients with metabolic syndrome were
found to be above 46 years of age contributing to 65% of total cases.
The prevalence of metabolic syndrome was found to be high in
older age groups when compared to younger population. However,
both the groups did not vary significantly in their age composition
(P = 0.829). The age distribution of the study population is shown in
Fig. 1.
Among the cases, 46% of them were male whereas 54% were
female. The male to female ratio was 1:1.7. Among the controls 40%
of them were male whereas 60% were females. The male to female
ratio was 1:1.5. The number of female cases is higher in comparison
to males in both study and control group. However, the difference
in gender composition of both the groups was not statistically
significant (P = 0.391).
3.1. Components of metabolic syndrome in the study subjects
The presence of each component of metabolic syndrome was
studied among female and male study subjects as shown in Table 1.
The prevalence of thyroid dysfunction was studied among cases
and controls along with different patterns of thyroid dysfunction
status among males and females study subjects (Table 2). The
difference in prevalence of thyroid dysfunction among cases and
controls was found to be statistically significant (P = < 0.001) as
shown in Fig. 2.
4. Discussion
The present cross sectional study aimed at evaluating the
thyroid function status in 100 patients with metabolic syndrome.
Patients were selected over a period of one year. The patients who
fulfilled 3 out of 5 components of joint committee criteria for
metabolic syndrome were noted. Anthropometry and routine
blood investigations along with thyroid and lipid profile measured
in overnight fasting states using standard laboratory techniques.
The mean age of the cases was 52.6  14.4 and of controls was
52.8  13.94 (Table 1, Fig. 1) and the peak incidence of thyroid
dysfunction was in 50–70 years of age groups. Similar results were
found in a study by Sudhakar et al. in 2011 and Otamen et al. with
the mean age of 52.68  10.2012 and peak incidence of thyroid
dysfunction in male 52.84  12.47 and female 52.78  12.3313
respectively.
The prevalence of metabolic syndrome is high among female in
comparison to male. 57% of cases with thyroid dysfunction were
female and 43% were male. However, there was no positive
correlation between thyroid dysfunction and age/sex of metabolic
syndrome cases. P value was not statistically significant.
A total of 56% were female (n = 56) and 46% were male (n = 46)
among cases and of 100 controls 60% were female (n = 60) and 40%
were male (n = 40) (Table 2, Fig. 2).
The overall prevalence of thyroid dysfunction in metabolic
syndrome was 51% in cases and that of controls was 12%. The
difference between both groups was statistically significant

Fig. 2. Prevalence of thyroid dysfunction among cases and controls.

Please cite this article in press as: M. Saluja, et al., Study of thyroid dysfunction in metabolic syndrome and association with its components,
Curr Med Res Pract. (2017), https://doi.org/10.1016/j.cmrp.2017.11.010
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Table 3
Components of metabolic syndrome and thyroid dysfunction.

Components Euthyroid Overt hypothyroid Overt hyperthyroid Subclinical hypothyroid Total P value
(49) (12) (2) (37)
Waist circumference (>90 cm in men; > 80 cm women) 31 09 00 31 71 0.025
Blood pressure (130/85 mm of Hg) 41 10 01 32 84 0.594
Fasting blood glucose (100 mg/dl) 40 10 02 30 82 0.923
Triglycerides (150 mg/dl) 35 11 01 23 70 0.241
HDL cholesterol (<40 mg/dl in men; <50 mg/dl in 34 10 02 24 70 0.504
women)

P < 0.05, significant, HDL – high density lipoproteins.

Bold values suggests that test results value is significant. Which is higher the waist circumference greater is the chances of thyroid dysfunction.

(P = < 0.001). Jayalal et al. showed that the overall prevalence of
thyroid dysfunction in patients with metabolic syndrome was
68%15 and Senthil et al. showed that thyroid dysfunction was seen
in 53.6% of metabolic syndrome patients.
Subclinical hypothyroidism (37%) was the commonest thyroid
dysfunction among metabolic syndrome cases followed by overt
hypothyroidism (12%) and overt hyperthyroid (2%). Out of the 100
cases with metabolic syndrome, 51% of patients had thyroid
dysfunction, of which 37% of total and 72.54% of cases had
subclinical hypothyroidism. Gyawali et al. in Kavre district of
central Nepal reported thyroid dysfunction in 31.84% of metabolic
syndrome patients, the most common dysfunction was subclinical
hypothyroidism (29.32%) followed by overt hypothyroidism
(1.67%) hyperthyroidism.16 Senthil et al. found subclinical hypo-
thyroidism in 37% and overt hypothyroidism in 14% metabolic
syndrome patients. Similarly, Jayalal et al. showed a high
prevalence of subclinical hypothyroidism (42%) and overt hypo-
thyroidism (26%) in the metabolic syndrome patients.15
In our study 70% of the cases had high triglycerides levels
(150 mg/dl) and 70% had low HDL cholesterol levels (<40 in
males and <50 in females). However, P value was not statistically
significant. Punia et al. reported that of the 360 patients included in
the study 62% had high TGL values, and 83% had a low HDL.18
Jayakumar et al. in his study of thyroid status in metabolic
syndrome included 120 patients of which 72 patients had low HDL
and 67 had high triglycerides values.19
Meher et al. showed that subclinical hypothyroidism was
significantly associated with metabolic syndrome and a linear
association was observed between TSH levels and total cholesterol,
triglycerides, LDL, and HDL cholesterol levels across the metabolic
syndrome group.14 However Tacrine O study stated that TSH was
not related with any metabolic syndrome parameters.17
The most common component affecting both male and females
was obesity (waist circumference above reference range). Al-
though the NCEP III guidelines state criteria for waist circumfer-
ence as >102 cm for male and >88 cm for female as obesity, the
amended criteria for south Asians are >90 cm for male and >80 cm
for female. In this study 71% had waist circumference above normal
reference range (>90 cm in men and >80 cm in women) and
percentage of obesity was more so common among females. In his
study Arthur et al. in pre and post menopausal women has proved
that post menopausal women had significant increase in the waist
circumference.20 In our study also increased waist circumference
was more in post menopausal women. Patients with high waist
circumference were found to be at increased risk of developing
thyroid dysfunction in comparison to those with normal
(P = 0.025). Sudhakar et al. in 2011 showed that women with
waist circumference of >88 cm had higher incidence of thyroid
dysfunction as compared to other components.
Thus, thyroid dysfunction is very much prevalent among
patients with metabolic syndrome specially the subclinical
hypothyroidism contributing as a major variety of thyroid
dysfunction. Thyroid function status should always be done as a
routine investigation in patients with metabolic syndrome.
Patients with high waist circumference should be screened at
the earliest as there is increased prevalence of thyroid dysfunction
in metabolic syndrome. Other indication of measuring thyroid
function status in metabolic syndrome is cardiovascular disease
risk prevention as it is well known that both thyroid dysfunction
and metabolic syndrome are independent risk factors for
cardiovascular disease.
The study concludes that thyroid dysfunction is one of the most
common endocrine disorder in metabolic syndrome patients.
Females were found to have higher incidence of thyroid dysfunc-
tion in comparison to males. Subclinical hypothyroidism was more
common pattern among thyroid dysfunction. Hence we recom-
mend study of thyroid function status in all patients with
metabolic syndrome or it should be included as a diagnostic
criterion for diagnosing metabolic syndrome.
Conflicts of interest
None.
Financial support
None.
Ethical approval
The authors declare that the study was performed in a manner
to conform with the Helsinki declaration of 1975, as revised in
2000 and 2008 concerning human and animal rights, and the
authors followed the policy concerning the informed consent as
per standards.
Acknowledgements
We are indebted to each of the study participants for the
substantial time and effort contributed to this study.
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