Also if a positive correlation between TSH and BMI has been observed in the majority of the studies, data on this topic remain controversial, especially when TSH values are in normal range.However, it is reasonable to argue that the high-normal levels of TSH found in obesity can be partly attributed to a silent autoimmune thyroiditis.The aim of the present study was to evaluate the interconnection between TSH and autoimmunity in obese patients with TSH values within the normal range. Methods:We enrolled 891 overweight and obese patients (209 Males), with TSH values in normal range (mean age ± SD: 45.1 ± 15 years.Anti thyroid auto antibodies(ATAs: thyroid-peroxides auto antibodies (TPOAb) and/or thyroglobulin auto antibodies(TgAb) and TSH were measured in all patients.The entire sample was then subdivided according to the tertiles of TSH within the range between 0.4 and 4.1 μUI/L. Results:No significant correlation between TSH and BMI was found within these groups.According to the presence (ATA+) or absence (ATA-) of ATAs, we found 225 (25,4%) ATA+ (32 males) and 665 ATA-(177 males) patients.A statistically significant correlation between TSH and BMI was found only in females with ATA positivity (Pearson: r = 0.1426, p= 0.04; Spearman: r = 0.1616, p = 0.02). Conclusion:In the initial assessment of obesity, the determination of TSH could be associate to ATAs, for identifying, among the patients with increased TSH, those affected by autoimmune thyroiditis.We suggest that in these patients, the beginning of LT4 therapy could be taken into account.

BACKGROUND: To estimate the prevalence of overweight and obesity among adolescents in Sardinia and to examine the association with several biological and geographic factors. METHODOLOGY: A cross-sectional study was performed in 3,946 unselected adolescents (2,011 boys, 1,935 girls; aged 11–15 years) attending the public secondary schools in 33 Sardinian municipalities: 28 semi-rural, 5 urban, sub-grouped according to their geographic location (mountain, hillside and plain). Oversized children were measured and their BMI defined as being above normal values according to parameters provided by the International Obesity Task Force (IOFT) by Cole et al. (BMI for age >= 95 th percentile). Relative risk for overweight and obesity was calculated using Poisson regression analysis: risks associated to each covariate were reciprocally adjusted. The 95% confidence interval (CI) of the estimated risk was calculated using Wald’s formula (RR, RR = log n ß±1.96se ß ). MAIN FINDINGS: The overall prevalence rate found for overweight and obesity was 14.9% (95% C.I.: 13.7–16.1%) and 3.7% (95% C.I. 3.1–4.3%), respectively. Overweight rate showed no association with gender, whereas belonging to the female sex constituted a significant protection against obesity. Increasing age in the range 12-14 years was protective against both overweight and obesity in the whole sample. A similar finding however was not observed for obesity in girls or overweight in boys, when considered separately. Boys, but not girls, living in urban areas displayed a modest though significant 20% increase in overweight and a 40% decrease in obesity risk. Living in a mountainous area conveyed a 30% decrease in risk of overweight and a 50% decrease in risk of obesity, when compared to living on the plains and hillside combined. However, the small sample size of study subjects living in mountainous areas generated extremely wide 95% confidence intervals, thereby preventing the drawing of any significant conclusions. CONCLUSION: In comparison with other surveys performed by the IOFT, Sardinian adolescents show a low prevalence rate for oversize, emphasizing a marked discrepancy with the general north-south rising trend of oversize observed throughout Europe. Geographic location, aesthetic or other age related factors seem to exert a different genderspecific influence on overweight and obesity. SIGNIFICANCE: The present report is cross sectional and the consequences of overweight and obesity on individuals over time are not traceable. However, the outcome of the study suggests the need to implement suitable policies and public health programs leading to increased awareness.

Recently, concentrations of serum carboxy-terminal-1-telopeptide (ICTP), a marker of bone collagen resorption, were found to be more sensitive than sex hormone-binding globulin (SHBG) in identifying peripheral overexposure to thyroid hormones in exogenous subclinical hyperthyroidism. The aim of the present study was to assess serum ICTP and SHBG in multinodular goiter with (pretoxic goiter) or without biochemical evidence of endogenous subclinical hyperthyroidism. Forty-five women affected by multinodular goiter were enrolled in this study. They were subdivided into two groups: group 1, consisting of 27 patients affected by pretoxic goiter; group 2, consisting of 18 patients affected by non toxic goiter; group 3, consisting of thirty-six euthyroid women matched with the other groups for age and lifestyle. In group 1, serum ICTP (mean +/- SD: 5.8 +/- 2.9 microg/l) concentrations were significantly higher when compared either to group 2 (3.6 +/- 1.2 microg/l; p < 0.02) or controls (2.7 +/- 0.7 microg/l; p < 0.0001); serum ICTP concentrations were also slightly but significantly higher in patients of group 2 compared to controls (p < 0.003). In contrast, mean serum SHBG concentrations did not show any difference among the three groups. No significant correlation was found between serum TSH and ICTP concentrations, while a weak positive correlation (p < 0.05) was only found between serum FT 3 and ICTP concentrations when data from the two patient groups were analyzed together. Moreover, when we subdivided patients into pre- and postmenopausal patients, we observed that SHBG but not ICTP serum concentrations were influenced by estrogenic status. In summary, the measurement of serum ICTP seems to be more suitable than SHBG for identifying those with a higher degree of peripheral thyroid hormone exposure in women affected by endogenous subclinical hyperthyroidism.

The relationship among iodine intake, goiter prevalence, and thyroid autoimmunity remains controversial. In the present article, we report the prevalence of antithyroid antibodies (ATA) in relation to iodine intake, frequency of goiter, and thyroid function in a large group of Sardinian schoolchildren living in areas with borderline iodine sufficiency, or mild to moderate iodine deficiency. A total of 8,040 schoolchildren (4,194 males, 3,846 females, ages 6-15 years) from 29 communities were examined between 1986-1994. Thyroid size was assessed by palpation, according to the Pan American Health Organization (PAHO) criteria. In all cases antimicrosomal (MAb) or antithyroid peroxidase antibodies (TPOAb) and thyrotropin (TSH) were assayed. Urinary iodine was determined in a subgroup of 820 children. ATA was detected in 235 (2.92%) sera (88 males, 2.12%; 147 females, 3.82%; chi2 = 20.41, p < 0.0001). ATA prevalence ranged between 0.0%-7.3% in the 29 communities without any geographical correlation with goiter prevalence and urinary iodine excretion. However, ATA was more frequently detected in goitrous children, especially in females. The presence of ATA was not age-dependent in males, whereas a significant increase of ATA was observed in females older than 11 years of age. Seventy-seven (0.96%) children showed borderline to slightly increased serum TSH (>5.2-32 mU/L). Increased serum TSH concentration was more frequently found in children with ATA, especially at higher titers. In summary, our study in Sardinian schoolchildren indicates: (1) ATA display geographical heterogeneity, which seems to be unrelated to goiter prevalence and/or to iodine supply; (2) ATA are more frequently detected in females older than 11 years of age, suggesting that puberty has a role in determining the predominance in females of thyroid autoimmunity; (3) although most goitrous children are ATA-negative, the prevalence of ATA is increased in children with enlarged glands; (4) ATA is associated with an increased prevalence of subclinical hypothyroidism.