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January 1, 2026Journal of Family Medicine and Primary CareOpen Access

Examining the association between thyroid dysfunction and metabolic syndrome components in a setting of high atherosclerotic heart disease risk factor prevalence: A cross-sectional study from Kochi, Kerala

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Key result

Thyroid dysfunction affects ~31% of metabolic syndrome patients, predominantly as subclinical hypothyroidism.

RR 1.509
95% CI 0.989-2.356
n=307

Why the study?

What is the prevalence of thyroid dysfunction and its association with individual metabolic syndrome components in adult patients with metabolic syndrome in Kochi, Kerala?

Key Points

To assess the prevalence of thyroid dysfunction and examine its correlation with individual metabolic syndrome components in a patient cohort with high cardiovascular disease risk.
Conducted a hospital-based cross-sectional study recruiting 307 consecutive patients aged 20–80 years diagnosed with metabolic syndrome via modified Asian ATP III criteria.
Assessed waist circumference, blood pressure, fasting blood glucose, and lipid profiles, with T3, T4, and TSH measured by electrochemiluminescence immunoassay.
Evaluated correlations between thyroid function tests and individual metabolic syndrome components using Pearson correlation coefficient analysis.
Thyroid dysfunction occurred in 30.6% of patients, predominantly as subclinical hypothyroidism in 26.7% (82/307), with a relative risk of 1.509 (95% CI, 0.989–2.356) in females compared to males.
The most prevalent metabolic syndrome component was fasting blood glucose > 100.0 mg/dL (86.3%), followed by increased waist circumference (83.1%), decreased HDL (61.6%), increased triglycerides (57.3%), and hypertension (46.3%).
Pearson correlation coefficient analysis showed no statistically significant association between any thyroid function test (TSH, FT4) and any metabolic syndrome component.

Study Design

Type

Cross-Sectional (n=307)

Multicenter

No

Structured PICO

What is the prevalence of thyroid dysfunction and its association with individual metabolic syndrome components in adult patients with metabolic syndrome in Kochi, Kerala?

P

Population

307 adult outpatients aged 20-80 years (mean age 50.25 years, 20.5% female) with metabolic syndrome and no previously known thyroid dysfunction or myocardial infarction at a single tertiary care center in Kochi, Kerala, India.

E

Exposure

Assessment of thyroid function status (TSH, T3, and T4/free T4 measured by electrochemiluminescence immunoassay [ECLIA]) and classification into euthyroidism, subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism, and overt hyperthyroidism

C

Comparator

Euthyroid status among metabolic syndrome patients (n=213) vs. thyroid dysfunction (n=94), and gender comparison (females vs. males); no non-MetS control group included

O

Outcome

Prevalence of thyroid dysfunction (overall and by subtype) in patients with metabolic syndrome and Pearson correlation coefficients (r) between thyroid profile parameters (TSH and free T4) and individual metabolic syndrome components (waist circumference, systolic/diastolic blood pressure, fasting blood glucose, total cholesterol, triglycerides, and HDL-C)surrogate

Main Result

Relative Risk: 1.509 (95% CI 0.989–2.356)

Limitations

Observational cross-sectional design precluded determination of cause-and-effect relationships
Lack of a control group without metabolic syndrome
Small sample size which could have affected the interpretation of correlations
Insulin resistance and anti-thyroid antibodies were not evaluated
Single-center hospital-based study limiting generalizability
Observational cross-sectional study design unable to establish cause-and-effect relationships
Did not include a control group
Small sample size which could have affected interpretation of correlations between thyroid dysfunction and metabolic syndrome components
Single tertiary care hospital setting in Kochi, Kerala limits generalizability

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Because thyroid dysfunction (predominantly subclinical hypothyroidism) is present in nearly one-third of metabolic syndrome patients without correlating with individual metabolic syndrome components, routine independent thyroid screening in metabolic syndrome patients is warranted to help mitigate overall ASCVD risk.

Abstract

A BSTRACT Introduction: Metabolic syndrome (MetS) and thyroid dysfunction (TD)—known atherosclerotic cardiovascular disease (ASCVD) risk factors—have each been separately documented to have significantly higher prevalence in the coastal urban population in Kochi, Kerala. This study aimed to assess the extent of overlap and association between these two entities, and their components, in such a scenario. Study Setting: Hospital-based cross-sectional study from December 2017 to January 2019 in a tertiary care center’s General Medicine Department. Materials and Methods: Patients aged 20–80 years fulfilling the inclusion criteria were consecutively recruited after written informed consent. Baseline demographic data was collected. Waist circumference (WC) and systolic/diastolic blood pressures (SBP/DBP) were recorded. Fasting blood glucose (FBG), total cholesterol (TC), serum triglycerides (TG), and high-density lipoprotein (HDL-C) levels were determined by an automated biochemical analyzer. Triiodothyronine (T3), thyroxine (T4), and thyroid-stimulating hormone (TSH) were estimated by the electrochemiluminescence immune assay (ECLIA). MetS was diagnosed based on the modified Asian National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) criteria. Pearson correlation coefficients were calculated to examine the association between MetS and TD components. Results: Of 307 included patients with MetS (244 [79.50%] male: 63 [20.50%] female), 30.6% had TD with relative risk in females higher at 1.509 (0.989–2.356). Among the MetS components, FBG > 100.0 mg/dL was the most prevalent (86.3%), followed by increased WC (83.1%), decreased HDL (61.6%), increased TG levels (57.3%), and increased SBP/DBP (46.3%). The most commonly detected TD was subclinical hypothyroidism in 82 (26.7%). Pearson correlation coefficient analysis showed no statistically significant association between any thyroid function test and MetS component. Conclusion: TD appears to evolve and present independently of MetS in this setting. This warrants their individual routine screening and identification, towards mitigating overall ASCVD risk.

Discussion

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Cite This Study

Minu et al. (2026) conducted a cross-sectional in Metabolic syndrome (MetS) (n=307). Thyroid dysfunction (assessed via TSH, T3, and free T4) vs. Euthyroid metabolic syndrome patients (and male vs. female comparison for relative risk of thyroid dysfunction) was evaluated on Prevalence of thyroid dysfunction (TD) in metabolic syndrome (with relative risk in females vs. males) and Pearson correlation with MetS components (RR 1.509, 95% CI 0.989-2.356). Thyroid dysfunction was present in 30.6% of metabolic syndrome patients (26.7% subclinical hypothyroidism; female RR 1.509) with no significant correlation with individual MetS components.

synapsesocial.com/papers/698829520fc35cd7a8849930 https://doi.org/10.4103/jfmpc.jfmpc_456_25

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