CC BY
0
DOI 10.5281/zenodo.10439954
UDC: 616.441-008.6-02:546.15-022.252:613.25
Niyazova Yo.M. assisstant
Department of Training of Family Doctors -1 Andijan State Medical Institute Uzbekistan, Andijan
OBESITY IN WOMEN WITH HYPOTHYROIDISM IN ANDIJAN DISTRICT OF ANDIJAN REGION
Abstract. In women with primary hypothyroidism living in the Andijan district (located in the Central part of the Andijan region) at the age of 30 - 60 years, the abdominal index, body mass index indicators are higher than the standard values. Indicators of the lipid spectrum — average levels of total cholesterol, triglycerides and the atherogenicity index are significantly higher, and high-density lipoproteins are significantly lower than in women without thyroid disorders. The study of thyroid status in women should be included in the list of mandatory examinations of obese patients. Women should be aware that a decrease in thyroid function can be a risk factor for overweight, obesity and the progression of complications.
Key words: hypothyroidism, thyroid-stimulating hormone, thyroid hormones, cholesterol, lipid spectrum, leptin, body mass index, obesity, overweight.
Introduction
Obesity is considered not just as an excessive accumulation of fat in the body, but as a chronic multifactorial recurrent disease associated with a number of serious cardiac, metabolic, rheumatological, oncological and other complications, disorders of psychosocial status and leading to early disability, as well as premature death. [3, 4]
Obesity is a widespread metabolic disorder worldwide, acquiring the character of a global pandemic. In 2015, 604 million adults and 108 million children suffered from obesity. Since 1980, the prevalence of obesity has doubled in 73 countries around the world [8]. According to the United Nations (UN), Mexico ranks first in the world in terms of the number of obese patients (32.8%), the Russian Federation is in 19th place (24.9%). [9-11]
Table №1
Uzbekistan The proportion of people suffering Average BMI Population in
from obesity value 26, 1 2019
16, 6% 32 981 716
Kyrgyzstan 16, 6% 26, 2 6 415 850
Turkmenistan 18, 6% 26, 4 5 942 089
Tajikistan 14, 2% 25, 4 9 321 018
Kazakhstan 21% 27, 4 18 551 427
Central Asian countries showing the percentage of the population that suffers from obesity as of 2019.[7]
If diseases of the cardiovascular system occupy a leading place among the causes of mortality in most developed countries, including Russia, obesity is among the potentially avoidable causes of fatal cardiovascular outcomes. [5]
However, obesity is not always indicated in the medical history. People suffering from overweight tend to exaggerate the width of their own figure, which leads to greater subjective dissatisfaction with the body image. [6]
Most often there is an exogenous-constitutional form of obesity caused by systematic overeating and irregular physical activity, a sharp restriction of physical activity without correcting the usual diet. Obesity is excess body weight, which is determined at a body mass index (BMI) > 30 kg/m2. Complications associated with obesity include cardiovascular diseases (especially in people with excess abdominal fat), diabetes mellitus, certain malignancies, gallstone disease, fatty liver degeneration, cirrhosis, osteoarthritis, disorders of the reproductive system in men and women, psychological disorders and, in people with a BMI >35 kg/m2, premature death. The diagnosis is based on the determination of BMI. Treatment consists in lifestyle changes (for example, diet, physical activity and behavior), and for certain patients - in prescribing medications or in performing bariatric (weight loss) surgery.
The purpose of the study is to assess the incidence of obesity and features of lipid metabolism disorders in women with primary hypothyroidism aged 30-60 years in the Andijan district of Andijan region. MATERIAL AND MEHODS
The study involved 164 women living in the Andijan district of Andijan region, aged 30 to 60 years, the average age was 36.0±2.26 [Iu 34.5; 95% CI 31.640.5] years. The control group included 60 women of the same age without thyroid disorders. The average age is 32.4±3.69 [Iu 32.0; 95% CI 25.1-39.6] years. Body mass index, abdominal index were determined (according to WHO definition, abdominal obesity corresponds to a waist-hip ratio of over 0.85 for women), thyroid hormone (T3, T4 free) and thyroid-stimulating hormone (TSH), lipid metabolism indicators were determined: total cholesterol (OHC), triglycerides (TG), high-density lipoproteins (CSLPVP), low-density lipoproteins (CSLPNP) with the calculation of the atherogenicity index (IA).
Exclusion criteria: pregnant and lactating women, patients with severe other endocrinological, somatic, neuropsychiatric disorders, smokers and persons
taking thyroid hormone preparations and women taking drugs acting on body weight.
RESULT AND DISCUSSION
Based on the results of the survey, it was revealed: overweight was detected in 64 (39.02%) women, 24 (14.63%) suffered from I-II degree obesity, 16 (9.75%) had a body weight deficit, 60 (36.58%) women had a BMI within the normal range. Among 64 overweight women, thyroid hypofunction was detected in 28 (43.75%) women. Out of 24 patients (bMI > 30 kg/m2 norm 18.5-24.9 m/kg2), 10 (41.6%) women suffered from obesity. Patients with hypothyroidism, in comparison with the control group, had statistically significantly high levels of TSH (norm 0.17-4.05 mMU/l), and BMI, in comparison with the control group. Correlation was revealed between BMI and TSH level (R = 0.5; p = 0.01). Statistically significantly higher levels of total cholesterol (4.97±0.43 mmol/L vs 3.38±0.32 mmol/L; P=0.05) and TG (2.03±0.30 mmol/l vs 0.94±0.10 mmol/l; P= 0.05), as well as a higher IA (3.33±0.27 vs. 1.91±0.35; P=0.01). Whereas the levels of HDL (1.13±0.03 mmol/L) were significantly lower than in the group without pathology (thyroid gland) (1.91±0.35 mmol/l; P=0.05). The content of LDL in women with hypothyroidism was elevated (2.70±0.17 mmol/l vs 2.20±0.21 mmol/l; (P=0.14).
Adipose tissue is a complex, heterogeneous endocrine organ, an anatomical depot differing in metabolic and secretory profile and realizing a special physiological function. It has an abundance of origin; development; proliferative ability; glucose and lipid metabolism; sensitivity to insulin, hormonal control, thermogenic capabilities, etc. Additional factors that determine the characteristics of adipose tissue are heredity, gender, age, environmental factors, compliance with the work and rest regime.
There is a link between thyroid hormones and obesity: just as primary hypothyroidism can affect changes in body weight, adipose tissue can change the level of thyroid hormones. The level of TSH in obesity is often elevated, which is associated with the action of leptin (a peptide hormone that regulates energy metabolism, which is mainly produced by fat cells and enterocytes in the small intestine. The hormone suppresses the feeling of hunger, which in turn reduces the accumulation of fat in adipocytes. [21] In the treatment of primary hypothyroidism with levothyroxine drugs, the weight loss is due to the loss of fluid, not fat. The correct use of selective analogues of thyroid hormones can help to reduce body weight by increasing energy consumption in overweight and obese patients while observing a hypocaloric diet, diet and proper lifestyle.
CONCLUSION
1. 64 (39.02%) women with primary hypothyroidism living in Andijan district of Andijan region were overweight, 24 (14.63%) suffered from obesity of I-II degree.
2. Among 64 overweight women, thyroid hypofunction was detected in 28 (43.75%) women. Out of 24 patients (BMI> 30 kg/m2 norm 18.5-24.9 m/kg 2), 10 (41.6%) women suffered from obesity.
3. A correlation was found between BMI and TSH levels, the average levels of OHS, TG and IA were significantly higher, and HDL cholesterol was significantly lower than in women without thyroid disorders.
4. Overweight and obese women should be advised to evaluate thyroid function, women should be aware that thyroid dysfunction can become a risk factor for weight changes, the development of obesity and the progression of complications.
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