Patients receiving any medication that may alter thyroid function and lipid profiles. Thyroid Hormones are important for multiple reasons. Thyroid hormones play an important role in regulating energy homeostasis. 1 They can stimulate expression of uncoupling proteins in the mitochondria of fat and skeletal muscle, modulate adrenergic receptor numbers by enhancing responsiveness of catecholamine, and thus regulate metabolic rate and body weight. 2 In addition, thyroid hormones can regulate lipoprotein and glucose metabolism and blood pressure. Thyroid function testing is obtained more frequently than any other endocrine screen in the evaluation of thyroid dysfunctions. The synthesis of thyroid hormone is almost entirely T 4 , but as iodine becomes scarce, the synthesis of T 3 increases.T 3 is the more active form of the hormone, and peripheral tissues can regulate the conversion of T 4 into either T 3 (more active) or rT 3 (not active). Thyroid hormones increase the metabolic rate of most tissues. Although it does not affect the metabolic rate of nervous tissue, it is absolutely necessary for postnatal brain maturation. TSH is regulated mainly by circulating T 4 , but the T 4 entering the thyrotrophs must be converted to T 3 before it affects the negative feedback loop. Thyroxine causes: Hyperthyroidism results from the excess synthesis of thyroid hormones by the thyroid gland. The prevalence of hyperthyroidism in the general population is about 0.5% and is associated with the Graves disease in 80% of cases. Other causes include toxic modular goitre, thyroid and pituitary adenomas, thyrioditis, use of exogenous thyroid hormones, thyroid carcinoma, hydatiform moles and stromal ovaries. Signs and symptoms of hyperthyroidism includes increases appetite, weight loss, palpitation, tachycardia, frequent bowel movements, menstrual disturbance, muscle weakness and catabolism of muscle protein, exophthalmia, lid lag, infrequent blinking and hyperactive deep tendon reflexes. In case of thyrioditis, patients may experience pain and tenderness in the thyroid region. ? Increase in BMR ? Increase in( D D D D ) F b) Hypothyroidism Hypothyroidism results from the inadequate production of thyroid hormone, and is classified as clinical or sub-clinical depending on the degree of clinical severity and the extent of abnormalities in thyroid indices. In overt or clinical hypothyroidism hormones level are low and TSH is elevated. Subclinical hypothyroidism describes a condition in which T 3 and T 4 levels are normal but TSH is elevated, or the TSH response to TRH infusion is exaggerated. The prevalence of clinical hypothyroidism is approximately 2% in women and less than 0.1% in men. 5 The significantly higher rate of hypothyroidism in women may reflect the stimulating effect of female reproductive hormones on immunologic function, producing greater rate of autoimmune disease in women. 6 The prevalence of thyroid antibodies is approximately 3 to 4 times higher in women compared with men and rise with age. Women aged 44 to 54, 21% to 26% have been found to have thyroid antibodies. 7 The prevalence of overt hypothyroidism also rises with age, particularly in women; coincident with the rise in the prevalence of autoimmune thyroiditis. 8 Subclinical hypothyroidism also predominates in women, occurring in approximately 75% of women and 3% in men. Elderly women are estimated to have up to 16% rate of subclinical hypothyroidism. 9 Hashimotos thyroiditis (chronic lymphocytic thyroiditis) is the most common cause of clinical hypothyroidism in the United States. Other causes include idiopathic atrophy, deficiency of dietary iodine, hypopituitrism, and hypothalamic disease resulting in deficiency TRH production and iatrogenic hypothyroidism (i.e. from medication such as lithium). In patients experiencing a severe medical condition, T 3 level may be low from decreased conversion of T 4 to T 3 a condition known as euthyroid sick syndrome. 10 Symptoms of hypothyroidism tend to manifest once TSH level surpass 8-12 mIU/L and include low energy appetite and sleep change, poor concentration, apathy and lung expanse latency. 11 Other symptoms include cold intolerance, constipation, muscle cramps, parathesis, mental disturbances (amenorrhea or menorrhagea) dyspenia dizziness, syncope, reduced hearing, poor appetite, weight gain, brittle and thinning hair, husky voice, bradycardia, cardiomegaly low voltage complexes on ECG, elevated levels of cholesterol and triglycerides and normochromic, normocytic anemia from a reduced rate of RBC production. The symptoms of hypothyroidism are correctable with thyroid supplementation but may not resolve until several weeks after the normalization of serum thyroid hormone levels. 12 Exogenous thyroid hormine is administered as L-thyroxin, I-triiodothyronine (Synthetic T 3 ), preparations of mixed synthetic T 4 and T 3 and desccated thyroid. L-thyroxin and L-triiodothyronine typically range between 25 to 100pgm/day and 12.5 to 50pgm/day respectively. # c) Subclinical Hypothyroidism Subclinical hypothyroidism (SCH) is defined as a serum thyroid-stimulating hormone (TSH) level above the upper limit of normal despite normal levels of serum free thyroxine. Serum TSH has a log-linear relationship with circulating thyroid hormone levels (a 2-fold change in free thyroxine will produce a 100-fold change in TSH). Thus, serum TSH measurement is the necessary test for diagnosis of mild thyroid failure when the peripheral thyroid hormone levels are within normal laboratory range. 13 The individual range for peripheral thyroid hormones is narrower than the population reference laboratory range; therefore, a slight reduction within the normal range will result in elevation of serum TSH above the normal range. Subclinical hypothyroidism or mild thyroid failure is a common problem, with a prevalence of 3% to 8% in the population without known thyroid disease. 14 The prevalence increases with age and is higher in women. After the sixth decade of life, the prevalence in men approaches that of women, with a combined prevalence of 10%. Antithyroid antibodies can be detected in 80% of patients with SCH have a serum TSH of less than 10 mIU/L. Before diagnosis of SCH, other causes of an elevated TSH level, such as recovery from nonthyroidal illness, assay variability, presence of heterophile antibodies interfering with the SCH assay, and certain cases of central hypothyroidism with biologically inactive TSH and thyroid hormone resistance, should be excluded. However, the most common cause of elevated TSH is autoimmune thyroid disease.Previous radioiodine therapy, thyroid surgery, and external radiation therapy can also result in mild thyroid failure. Transient SCH may occur after episodes of postpartum, silent, and granulomatous thyroiditis. 15 The clinical importance of and therapy for mild elevation of serum TSH (<10 mIU/L)5 and the exact upper limit of normal for the serum TSH level remain subjects of debate. 16 When the TSH is above 10mIU/L, levothyroxine therapy is generally agreed to be appropriate.However, management of patients with a serum TSH level of less than 10 mIU/L is controversial. 17 Some authors argue for routine and some for selective therapy. A recent 2007 meta-analysis of 14 randomized clinical trials enrolling a total of 350 patients concluded that levothyroxine replacement therapy for SCH does not result in improved survival or decreased cardiovascular morbidity. Data on health-related quality of life and symptoms did not show significant differences between intervention groups. Some evidence indicates that levothyroxine replacement improve some parameters of lipid profiles and left ventricular function. 18 clinical feature of hypothyroidism, but subtle somatic symptoms, cognitive defects have been observed in association with this condition. symptoms include dry skin, cold intolerance, fatigue, alteration in lipid metabolism and cardiac function and lower score on memory tests. These symptoms had improved by thyroid hormone treatment. Approximately 5 to 15% of patients with subclinical hypothyroidism progress to overt hypothyroidism within a year. Patients with any thyroid antibodies are at high risk, 80% progressing to overt hypothyroidism within four years. # III. Results The study sample comprises 118 subjects, fulfilling the inclusion criteria were recruited in the study with their consent. After detailed history and clinical evaluation, blood sample was taken for estimation of various biochemical parameters in serum namely fT 3 , fT 4 , TSH, Insulin, Triglycerides, HDL-C, and fasting glucose. The results obtained are presented in various tables diagrams. # a) Sex Distribution of Metabolic Syndrome The sex distribution of prevalence of metabolic syndrome is shown in Table 1. The percentage of male and female in metabolic syndrome were 20% and 38.4% respectively of total subjects in the study. # c) Distribution of Metabolic Syndrome in Thyroid Groups Out of total 118 subjects studied 60 were in overt hypothyroid group and 58 in subclinical hypothyroid group. Among these groups metabolic syndrome is almost equally distributed. Similarly male and female subjects were almost equal in both groups with more number of females (n =22 and n = 24) in overt and subclinical hypothyroid groups respectively. Results in Table 2. In overt hypothyroid case fT 3 is negatively correlated with systolic blood pressure, fasting glucose triglyceride level and HDL levels. T 3 negatively correlated with systolic blood pressure and HDL-C level in subclinical hypothyroid group. Results in Table 5 Table 5 was found between fT4 and any of the components of metabolic syndrome. 8. The -HOMA-IR (insulin resistance) is comparable is overt (5.38±3.4) and subclinical hypothyroid (6.27±3.87) groups. Therefore screening and treatment of subclinical hypothyroids may be warranted due to its adverse effect on glucose metabolism Hence the fact that insulin resistance was similar in both thyroid groups where there is significant difference in the levels of thyroid hormones indicate that thyroid hormone per se may not be responsible for this phenomenon. 9. Elevated triglyceride is the most prevalent (81%) component of metabolic syndrome in all thyroid patients of present study. Hence hypertriglyceridemia on routine evaluation may warrants screening for other components of metabolic syndrome. 10. There is a significant correlation (p= 0.03) between waist circumference and triglyceride levels. It is the visceral fat which is responsible for hypertriglyceridemia. Hence it can be concluded that those having high TG levels and high waist circumference, have visceral adiposity. Therefore screening for other parameters of metabolic syndrome may be warranted as visceral adipose tissue causes the most metabolic derangements. The Various results conclude that a significantly deep association exists between Thyroid dysfunction and Metabolic Syndrome. # Volume XV Issue III Version I ![. Introduction and Text lace of Study: The study was conducted in the Department of Biochemistry, Santosh Medical College and Department of Medicine, Santosh Hospital, Ghaziabad (U.P.) Sample Size and Sample Frame: A total of 118 cases were studied. Period of Study: 1.5 Years Inclusion Criteria: Patients attending the Endocrinology clinic and Medicine OPD with clinical diagnosis of hypothyroidism. Exclusion Criteria: Patients with known diabetes with or without treatment, severe liver, heart and renal failure.](image-2.png "I") Year 2 015 1SexMetabolic SyndromeNon Metabolic SyndromeTotalMale24 (20%)19 (16.1%)43 (36.4%)Female45 (38.4%)30 (25.4%)75 (63.5%)Total69 (58.4%)49 (41.5%)118b) Age Wise Distribution of Metabolic Syndromeyears and we can observe that maximum numbers ofThe prevalence of metabolic syndrome ishypothyroid patients are in age group of 30-39 yearsincreasing with age with maximum in age group 40-49with 59% of prevalence of metabolic syndrome. 1Age classes (years)All patients (n)Metabolic Syndrome (n)20-2917 (14%)5 (29%)30-3949 (41.5%)29 (59%)40-4922 (18.6%)16 (72%)50-5918 (15%)7 (38.8%)60-6912 (10%)7 (58.3%) 2Year 2 015Volume XV Issue III Version ID D D D ) F(ResearchMedicalMet syn F 22 F 24 In overt hypothyroid group, both metabolic and Overt Hypothyroid M 12 Subclinical Hypothyroid M 11 Total 69 d) Thyroid Function Test in Metabolic Syndrome non metabolic syndrome group, fT 3 , fT 4 are comparably decreased but TSH is significantly increased in metabolic syndrome group. Global Journal of Non Met Syn Total Total 26 60 34(56%) Total 23 58 35(60%) 49 118 3fT 3fT 4TSHOvertNon Met Syn 2.4 ±6.4 ±11.5 ±hypothyroid1.122.144.8Met Syn2.737.30 ±14.6 ±±2.805.42*1.32SubclinicalNon Met Syn 5.6 ±14.9 ±8.24 ±Hypothyroid1.122.45.28Met Syn5.1 ±16.2 ±9.1 ±1.172.85.03*p <0.05 4Overt HypothyroidSubclinical HypothyroidNon Met SynMet SynNon Met SynMet SynWC (inch)32.8 ± 2.536.9 ± 3.633.3 ± 2.437.17 ± 3.12SBP (mmHg)127.6 ± 12.7136.7 ± 17.1123 ± 11.1138.4 ± 15.4DBP(mmHg)83.9 ± 7.189.2 ± 9.784 ± 7.391.39 ± 10.67FG(mg/dl)90.7 ± 16.0111.8 ± 19.2*95.2 ± 11.2136 ± 33.1*TG(mg/dl)136.3 ± 33.1198.1 ± 58.6*175.2 ± 52155.29 ± 45.65HDL(mg/dl)44.2 ± 8.241.9 ± 8.344.6 ± 8.841.73 ± 8.98*p<0.05 in comparison to subclinical hypothyroidism by student test 19.49%25.42%MALE WITH M.S.FEMALE WITH M.S.Year 2 01516.10%NON M.S. MALE NON M.S. FEMALE1038.98%Volume XV Issue III Version ID D D D ) F(ResearchMedicalGlobal Journal ofWC (inch) SBP (mmHg) DBP(mmHg) FG(mg/dl) TG(mg/dl)Overt Hypothyroid P value -0.338 r 0.03* -0.008 0.951 0.034 0.796 -0.177 0.176 -0.174 0.184Subclinical Hypothyroid r P value -0.269 0.04* -0.148 0.268 0.062 0.643 0.025 0.851 -0.023 0.864HDL-C(mg/dl)-0.0250.849-0.1960.141fT 4 is negatively correlated with waistcircumference, fasting glucose, triglycerides and HDLlevels in overt hypothyroid group. Similarly in subclinicalgroup there is negative correlation with waistcircumference and systolic blood pressure. Result inTable 6. 6Overt HypothyroidSubclinicalHypothyroidrP valuerP valueWC (inch)-0.08450.518-0.0610.735SBP (mmHg)0.1430.276-0.1370.305DBP(mmHg)0.0630.6330.0560.675FG(mg/dl)-0.0690.5990.0440.743TG(mg/dl)-0.0460.7250.1770.184HDL-C(mg/dl)-0.1920.1410.0440.743IV. Summary and Conclusion1. In the present study females hypothyroid caseshave more prevalence of Metabolic syndrome{n=45 (38.4%)}, than male hypothyroid cases {24(20%)} Hence it will be worthwhile to screen femalepatients with hypothyroidism, for risk of metabolicsyndrome.2. Highest prevalence of metabolic syndrome inhypothyroid patient was in 40-49 years of age group{total n=22, cases of metabolic syndrome is n=16(72%)}. This is also the age group where there ishighest risk of subclinical hypothyroidism.3. The prevalence of Metabolic Syndrome iscomparable in overt hypothyroid cases {56%(n=34)} and subclinical hypothyroid cases {60%(n=35)}. Hence this warrants the intensivescreening of subclinical hypothyroid group.4. TSH values were high in metabolic syndrome group(14.6 ± 5.42 mIU/L) in comparison to non metabolicsyndrome group (11.5±4.8 mIU/L) in both thethyroid groups. Therefore patients with higher TSHin subclinical hypothyroidism are not more risk ofdeveloping metabolic syndrome.5. When components of metabolic syndromes werecompared, overt hypothyroid group had significantlyelevated triglyceride levels (198.1±58.6 mg/dl) thansubclinical hypothyroid group (155.29±45.65 mg/dl)and subclinical hypothyroid group had significantlyelevated fasting glucose (136±33.1 mg/dl) ascompared to overt hypothyroid group (111.8±19.2mg/dl). Hence it can be made out that subclinicalpatents are at higher risk of metabolic syndrome asthey also had greater mean of abdominal obesity,and diastolic blood pressure.6. TSH had significant positive correlation with fastingglucose (r=0.337, p=0.009), diastolic bloodpressure (p = 0.049) and triglycerides level(p=0.40) in overt hypothyroid cases. In subclinicalcases TSH is negatively correlated with fastingglucose and HDL-C levels and significant positivecorrelation with diastolic blood pressure.7. fT3 had significant negative correlation withabdominal obesity in both overt and subclinicalhypothyroid group and no significant correlation © 2015 Global Journals Inc. (US) © 2015 Global Journals Inc. (US) Latest Insight into the Relation of Metabolic Syndrome with Thyroid Dysfunction * Effect of obesity and starvation on thyroid hormone, growth hormone and cortisol secretion LDouyon DESchteingart Endocrinol Metab Clin North Am 31 2002 * Resting energy expenditure is sensitive to small dose change in patients with chronic thyroid hormone replacement HAdsani LJHoffer JESilva J Clin Endocrinol Metab 92 1997 * The rore of thyroid hormone in blood pressure homestasis: evidence from shortterm hypothyroidism in humans EFommei GIervasi J clin Endocrinol Meta 87 2002 * The management of hyperthyroidism Ja-Franklin N Eng J Med 330 1994 * The epidemiology of thyroid disease and implications for screening CWang LMCrapo Endocrinol Metab Clin North Am 26 1997 * The effect of changing thyroid function on cyclic effective illness in human subjects MSBauer PCWhybrow Am J paychiatry 143 1986 * Prevalence of thyroid antibodies among healthymiddle-aged women ENMassoudi Ms' Meilahn Ann of Epidemiology 5 1995 * Prevalence of thyroid hormone autoantibodies in healthy subjects SSakata MMatsuda TOgawa Clin Endocrinol 41 1994 * Subclinical hypothyroidism is mild thyroid failure and should be treated MTMcdermott ECRidgway J Clin Endocrinol Metab 86 2001 * Subclinical thyroid disease SmiSurk EOcampo Am J Med 100 1996 * Evaluation of lipid profile in hypothyroid patients. Our experience Goswami B VKGupta VMallika Thyroid Res Pract 5 2008 * The beneficial effect of L-thyroxin on cardiovascular risk factors, endothelial function, and quality of life in subclinical hypothyroidism: randomized, crossover trial SRazvi LIngoe GKeeka COates CMcmillan JUWeaver J Clin Endocrinol Metab 92 2007 * Subclinical hypothyroidism DSCooper N Engl J Med 345 4 2001 * Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) JGHollowell NWStaehling WDFlanders J Clin Endocrinol Metab 87 2002 * Subclinical hypothyroidism: when to treat, when to watch VFatourechi consultant 44 2004 * Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism MISurks JGHollowell J Clin endocrinol Metab 92 2007 * The treatment of subclinical hypothyroidism is seldom necessary JWChu LMCrapo J Clin Endocrinol Metab 86 10 2001 * Effects of reducing the upper limit of normal TSH values VFatourechi GGKlee SKGrebe * JAMA 290 24 2003