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Clinical track

  • A.c.hoppenbrouwers@gmail.com schreef:

    Thanks for this interesting case report.
    I have a different question then the subject of your abstract actually. What did you think of the labresult showing subclinical hypothyreoidism?
    (I have often difficulty explaining this to my patients; who are referred with weight gain and slightly elevated TSH and are informed by google that I should prescibe levothyroxine immediatly)

    • M. Welling (Rotterdam) schreef:

      Thanks for the interesting question!

      Subclinical hypothyriodism, or TSH resistance, is something we see often in our patients with obesity
      The reason behind this is not known for certain, some say this is due to higher conversion rates from T3 to T4, others hypothesise that the large quantities of leptin stimulates TRH and consequently TSH, leading to TSH resistance. Moreover, it can be due to the chronic inflammatory state in obesity.
      Concluding: most of the times the TSH resistance is a consequence of their obesity, not the cause (in patients without thyroid related diseases in their medical history)

      If there are no complaints related to hypothyroidism, we assume that there is no real deficiency of T3 or T4 and that there is obesity induced TSH resistance.
      In that case, we do not act upon this immediately in our obesity centre. The best treatment for this TSH resistance, is losing weight!

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