The Change Of Serum Ghrelin Levels When Thyroid Dsyfunction

Objective: Thyroid disease is common disease and frequently-occurringdisease in the endocrine system．Common Thyroid disease have autoimmunethyroid diseases (such as GD and HT) and infectious thyroid diseases (such assubacute thyroiditis) thyroid. The various stages of their course show differentthyroid dysfunction. Ghrelin is a kind of new brain-gut peptide, which isConsisted by28amino acid residues.It has correlation with energy metabolism,digestion, absorption. And it also has correlation with inflammatory andcardiovascular diseases outcomes. In recent years, the researchs on ghrelinlevel changes in autoimmune thyroid disease become more and more. But theconclusion is inconsistent.And there is no research reports regard infectiousthyroid diseases as subjects. In this study,we will observe the changes inserum ghrelin levels in Patients with thyroid dysfunction that Caused bydifferent causes, and analyze the relationship between serum ghrelin levelsand thyroid hormone、thyroid-related antibodies、blood glucose、blood lipids、body fat and other facts，to further explore the effection on abnormal thyroidfunction and cause to serum ghrelin levels.Methods: We choose four groups subjects to study, the normal controlsgroup wereselected from the Medical Examination Center in the SecondHospital of Hebei Medical University during September and October in2013,including male8cases and female16cases.Both of their thyroidfunction、thyroid antibodie、fasting blood glucose, and postprandial2hour’sblood glucose values,blood fat and thyroid ultrasonography are within thenormal range，and they have no thyroid disease or a history of otherautoimmune diseases.Research groups include the patients who are newlydiagnosed by the Endocrinology Department in the Second Hospital of HebeiMedical University，and all of them have the typical clinical symptoms.what’s more the course of disease are less than2months，and related medicationshave not been applied on them before. Group of Graves’Diseaseareautoimmune hyperthyroidism ones, including male8cases and female16cases，who’s mean ages were (33.71±9.25) years old. Group of HashimotoThyroiditis are autoimmune hypothyroidismpatients(contain clinicalhypothyroidism and subclinical hypothyroidism), which including30cases,male5cases and female25cases,who’s mean ages were (37.57±13.68) yearsold. Group of Subacute Thyroiditis is total of28cases, including male11cases and female17cases，who’s mean ages were（39.32±10.00）.The patientsin this group are pain Subacute thyroiditisones with a high state ofthyrotoxicosis.All of the volunteers do not have the history of diabetes,chronichypertension, coronary heart disease,cerebrovascular diseaseand or otherchronic medical history,while they are not associated with other autoimmunesystem, blood system dieases or malignant tumor history, and except for acuteand chronic infection, liver and kidney function damage.All subjects were recorded height, weight, and other general information,furthermore calculate the percentage of body fat,（BF%=(1.20×BMI)+(0.23×age)(10.8×sex)5.4，1for male and0for female）.They were collectedvenous blood save to-70℃refrigerator for measuring biochemicalindexes,thyroidfunction, fasting blood glucose.Except that,in GD group we collectedThyrotropin Receptor Antibody(TRAb) in additio-n, in ST group werecollected Erythrocyte Sedimentation Rate(ESR)、High-Sensitivity C-reactiveProtein(HS-CRP) in addition, and HT group were collected Thyroglobulinantibody(TGAb) and Anti-thyroid Peroxidase Antibodies(TPoAb). Bloodghrelin was determined by ELISA double antibody sandwich.SPSS19.0statistical software is used to deal with all data. The data istested normally. According to the normal distribution of the data adoptmean±standard deviation, variance analysis comparing the selection amongmultiple groups, between the two groups was compared with S-N-K method;non-normal data using the median, four percentile interval representation,comparisons between groups using rank sum test. Spearman correlation analysis between the two indexes by correlation, multiple regression analysisand non-conditional logistic regression analysis and multiple stepwiseregression analysis using. All tests were two-sided, P<0.05had statistical.Result:1Comparison between the age, weight, sex ratio， there were nosignificant differences between four groups (P>0.05). The body fat percentagewas no significant difference in total,but HT group were significantly higherthan the other three groups (P<0.05).2Comparison of the thyroid functionin in the four groups, the levels ofFT3, FT4in GD and SAT group were significantly higher than NC group.In HTgroup，the levels of FT4was lower than NC group,(P <0.05), but there has nosignificant difference in FT3between them(P>0.05).3Ghrelin comparison between the four groups: the levels of serumghrelin in GD group> SAT group> HT group>NC group, the difference wasstatistically significant (P <0.05).4Compartion of lipid between the four groups show that differences intriglyceride levels among the four groups was not statistically significant(P>0.05). Total cholesterol in group HT was higher than in group NC(P<0.05), group GD and SAT arelower than in group NC (P <0.05). Highdensity lipoprotein in GD and SAT group were lower than in NC group (P<0.05), while no significant difference between the HT and NC group (P>0.05).The low density lipoprotein was higher in group HT than in NC, andlower in GD group than that in NC, the difference between SAT and NC groupwas not statistically significant (P>0.05).5Compartion of blood glucose between the four groups show that thelevels in group GD and SAT were significantly higher than group NC andHT(P<0.05)，but the difference between GD and SAT group or NC and HTgroup was not statistically significant(P>0.05).6By Spearman correlation tests of all subjects, the level of serum ghrelinwas positively correlated with FT3、FT4、 TRAb、HS-CRP. While TSH、CHOL、LDL、HDL showed a negative correlation; There was no significant correlation with the TPoAb、 body fat percentage、TG、GLU、TGAb、Age、ESR.In GD group correlation analysis showed: ghrelin and blood lipids, TRAbwere not correlated; SAT group shows: ghrelin and blood lipids were notcorrelated, but with the age was positively correlated; HT group showed:ghrelin were not correlated with TGAb and TPoAb,but it shows a positivecorrelation tendency.7By Multiple Stepwise Regression（ghrelin as dependent variable, bodyfat percentage、CHOL、TG、LDL、HDL、Glu、TSH、FT3、FT4、TPoAbas the independent variable），we candraw a conclusion：ghrelin levels aregreatly influenced by FT4， regression coefficient and the p value is0.532and0.000. But when the group was applied to analyze, the GD and HT groupshowed consistent with the results.In SAT group, ghrelin levels are greatlyinfluenced by FT3, regression coefficient and the p value is0.532and0.000.Conclusion:1This research shows that: the serum ghrelin levels will change whenthyroid dysfunction，serum ghrelin levels in patients suffering from Graves’disease hyperthyroidism, thyrotoxicosis period of subacute thyroiditis andhashimoto’s thyroiditis hypothyroidism are all elevated.2This research shows that: Graves’ disease hyperfunction, subacutethyroiditis thyrotoxicosis and hashimoto’s thyroiditis hypothyroidism patientsserum ghrelin levels was positively correlated with FT3、FT4,and negativecorrelated with TSH.when analyze overall, FT4is the determinant to effect thechange of ghrelin.But FT3is the determinant to effect the change of ghrelin inSAT group. These Suggest thyroid hormone affect the level of serum ghrelinin different degrees.3This research shows that:During subacute thyroiditis thyrotoxicosis thelevel of serum ghrelin was positively correlated with HS-CRP. During Graves’disease hyperfunction and hashimoto’s thyroiditis hypothyroidism, it is notshowed a statistically significant correlation between Serum ghrelin level withanti-thyroid autoantibodies. But it shows a positive correlation tendency. Ifincreasing the number of cases may have a new discovery. Thus we can inferthat ghrelin may be associated with the body’s immune or inflammatory statein certain extent.4This research shows that: Thyroid dysfunction accompany withdisorder of lipid metabolism. Serum CHOL, LDL and HDL is low inhyperthyroidism, serum CHOL and LDL is high in hypothyroidism. Serumghrelin levels was negative correlated with CHOL、HDL and LDL.the causethat thyroid dysfunction accompany with disorder of lipid metabolism may beapartly the change of ghrelin level which is caused by Thyroid dysfunction.Thus we can speculate that thr change of ghrelin level affect the lipidmetabolism in thyroid disease.