Journal of Science and Technology Vol.

14 June /2013
ISSN -1605 – 427X
Natural and Medical Sciences (NMS No. 1)
mena@sustech.edu

Assessment of Lipids Profile in Hyperthyroidism Sudanese Patients in North

Kordofan State, Sudan

Waleed HajMusa Altahir*1, Mohamed AbdelRahim Abdella 2, Elsadig Mohamed Ahemd3 and
Ammar Ismail4

*1. Department of Medical Laboratory, Faculty of Medicine and Health Sciences, University of
Kordofan (Elobeid) - Republic of the Sudan. Email: waly79@yahoo.com.
2. Department of Biochemistry, College of Medical Laboratory Sciences – Sudan University of
Science and Technology (SUST) - Republic of the Sudan.
3. Department of Clinical Chemistry, Faculty of Medicine and Health Sciences, University of
Elimam Elmahdi, Kosti – Republic of the Sudan.
4. Department of Biochemistry, College of Medical Laboratory Science, Al-Neelain University -
Republic of the Sudan.

ABSTRACT
The objective of this study was to find out possible relationship between thyroid hormones and lipids
profile levels in Elobeid city, North Kordofan State, during the period from March 2011 to March
2012. A total of 250 subjects were selected for this study. Out of 250 subjects, 150 were patients,
Female to Male ratio was 2.75: 1.0 (100 patients were hyperthyroidism before treatment (new cases),
50 patients were currently under treatment (Evert hyperthyroidism) and 100 were apparently healthy
individuals (ascertained as controls). Thyroid hormones were measured using ELISA technique. For
cholesterol, triglycerides using enzymatic spectrophotometeric method and precipitation enzymatic
method for HDL-C and LDL-C.T3 and T4 were significantly increased in new cases (3.9 ± 1.1 p-
value <0.00) and (16.9 ±3.1 p-value <0.00) compared with control group (1.08 ± 0.4) and (8.07 ±
1.6) for T3 and T4, respectively.TSH was significantly reduced (0.05 ± 0.06 p-value <0.00) compared
with control (2.6 ± 0.17). In patients under treatment T3, T4 and TSH were not altered in comparison
with control p-value (0.272, 0.633 and 0.061), respectively. Lipids profile, the total Cholesterol,
LDL-C and HDL-C were significantly decreased (107 ± 10.9 p-values <0.00, (46.6 ± 10.4 p-values
<0.039), and (35.6 ± 3.3 p-values <0.00) in compression with control groups (154 ± 67), (52 ± 7.2)
and (79.3±12.9) for lipds profile respectivly. There was negative correlation between the level of
lipids profile and thyroid hormones level (T3 and T4) and positively correlated with the triglycerides.
It was concluded that T3 and T4, as well as triglycerides, are elevated in hyperthyroidism, while
cholesterol is decreased.

‫ﺍﻝﻤﺴﺘﺨﻠﺹ‬
‫ﻫﺩﻓﺕ ﻫﺫﻩ ﺍﻝﺩﺭﺍﺴﺔ ﺍﻝﻰ ﺍﻴﺠﺎﺩ ﺍﻝﻌﻼﻗﺔ ﺒﻴﻥ ﻫﺭﻤﻭﻨﺎﺕ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﻭﻤﺴﺘﻭﻯ ﺍﻝﺩﻫﻭﻥ ﻓﻲ ﺍﻝﺒﻼﺯﻤﺎ ﻝﺩﻱ ﺍﻻﺸﺨﺎﺹ ﺍﻝﻤﺼﺎﺒﻴﻥ ﺒﻔﺭﻁ‬
(1: 2.75 ‫ ﺸﺨﺼﺎ ﻤﺼﺎﺒﺎ ﺒﻔﺭﻁ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﻤﻥ ﺍﻝﺠﻨﺴﻴﻥ )ﻨﺴﺒﺔ ﺍﻻﻨﺎﺙ ﻝﻠﺫﻜﻭﺭ‬150 ‫ ﺸﺨﺼﺎ ﻤﻨﻬﻡ‬250 ‫ ﺸﻤﻠﺕ ﺍﻝﺩﺭﺍﺴﺔ‬.‫ﺍﻝﺩﺭﻗﻴﺔ‬
(‫ ﺸﺨﺹ ﻤﺼﺎﺏ ﺘﺤﺕ ﺘﺎﺜﻴﺭ ﺍﻝﻌﻼﺝ‬50‫ ﺸﺨﺹ ﻤﺼﺎﺏ ﺒﻨﺸﺎﻁ ﺍﻝﻐﺩﻩ ﻗﺒل ﺘﻨﺎﻭل ﺍﻝﻌﻼﺝ ﻭ‬100 ) ‫ﺘﻡ ﺘﻘﺴﻴﻤﻬﻡ ﺍﻝﻲ ﻤﺠﻤﻭﻋﺘﻴﻥ‬
‫ ﺘﻡ ﺘﺤﻠﻴل ﻋﻴﻨﺎﺕ ﻫﺭﻤﻭﻨﺎﺕ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﺒﺎﺴﺘﺨﺩﺍﻡ ﺘﻘﻨﻴﺔ ﺍﻻﻨﺯﻴﻡ ﺍﻝﻤﻨﺎﻋﻲ‬.‫ ﺸﺨﺹ ﺍﺼﺤﺎﺀ ﻜﻤﺠﻭﻋﺔ ﻀﺎﺒﻁﺔ‬100 ‫ﺒﺎﻻﻀﺎﻓﻪ ﺍﻝﻰ‬
.‫ﺍﻝﻤﺭﺘﺒﻁ ﺒﻴﻨﻤﺎ ﺘﻡ ﺘﺤﻠﻴل ﻋﻴﻨﺎﺕ ﺍﻝﺩﻫﻭﻥ ﺒﺎﻝﻁﺭﻴﻘﺔ ﺍﻻﻨﺯﻴﻤﻴﺔ ﺍﻝﻤﻌﺘﻤﺩﺓ ﻋﻠﻰ ﺍﻝﻤﻁﻴﺎﻑ ﺍﻝﻀﻭﺌﻲ‬
‫ ﻭﺃﻥ ﻗﻴﻤﺔ‬0.00 ‫( ﺫﻭ ﺩﻻﻝﻪ ﻤﻌﻨﻭﻴﻪ ﺍﻗل ﻤﻥ‬3.9 ± 1.1 = T3 ) ‫ﺃﻭﻀﺤﺕ ﺍﻝﻨﺘﺎﺌﺞ ﺍﻥ ﻫﻨﺎﻙ ﺯﻴﺎﺩﺓ ﻓﻲ ﻫﺭﻤﻭﻨﺎﺕ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ‬
T4

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Journal of Science and Technology Vol. 14 June /2013
ISSN -1605 – 427X
Natural and Medical Sciences (NMS No. 1)
mena@sustech.edu

‫ ﺘﺴﺎﻭﻱ‬T4‫( ﻭ‬1.08±0.4 = T3 ) ‫ ﻋﻨﺩ ﺍﻝﻤﻘﺎﺭﻨﻪ ﻤﻊ ﺍﻝﻤﺠﻤﻭﻋﻪ ﺍﻝﻀﺎﺒﻁﻪ‬.0.00 ‫( ﺫﺍﺕ ﺩﻻﻝﺔ ﻤﻌﻨﻭﻴﺔ ﺍﻗل ﻤﻥ‬16.9±3.1)
.‫ ﺒﻴﻨﻤﺎ ﻝﻡ ﻴﺤﺩﺙ ﺘﻐﻴﺭ ﻓﻲ ﻫﺭﻤﻭﻨﺎﺕ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﻝﺩﻯ ﺍﻻﺸﺨﺎﺹ ﺍﻝﻤﺼﺎﺒﻴﻥ ﺍﻝﺫﻴﻥ ﻫﻡ ﺘﺤﺕ ﺘﺎﺜﻴﺭ ﺍﻝﻌﻼﺝ‬.(8.07±1.36)
‫ﻋﻨﺩ ﻤﻘﺎﺭﻨﻪ ﺘﺭﻜﻴﺯ ﺍﻝﺩﻫﻭﻥ ﻓﻲ ﺍﻝﻤﺭﻀﻰ ﺍﻝﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﻓﺭﻁ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﻗﺒل ﺘﻨﺎﻭل ﺍﻝﻌﻼﺝ ﺒﺎﻝﻤﺠﻤﻭﻋﺔ ﺍﻝﻀﺎﺒﻁﺔ ﺘﺒﻴﻥ ﻭﺠﻭﺩ‬
‫ ﻜﻠﺴﺘﺭﻭل ﺍﻝﺒﺭﻭﺘﻴﻥ ﺍﻝﺩﻫﻨﻲ ﻤﻨﺨﻔﺽ ﺍﻝﻜﺜﺎﻓﻪ‬,(107.3 ±10.9)‫ ﻓﻲ ﻤﺴﺘﻭﻱ ﺍﻝﻜﻠﺴﺘﺭﻭل‬0.00‫ﺍﻨﺨﻔﺎﺽ ﺫﻭ ﺩﻻﻝﻪ ﻤﻌﻨﻭﻴﻪ ﺍﻗل ﻤﻥ‬
‫( ﻭ‬154±67), (52±7.2) ‫( ﻤﻘﺎﺭﻨﺔ ﺒﺎﻝﻤﺠﻤﻭﻋﺔ ﺍﻝﻀﺎﺒﻁﺔ‬35.6±3.3) ‫( ﻭﻜﻠﺴﺘﺭﻭل ﺍﻝﺒﺭﻭﺘﻴﻥ ﺍﻝﺩﻫﻨﻲ ﻋﺎﻝﻲ ﺍﻝﻜﺜﺎﻓﺔ‬46.9±10.4)
‫( ﻤﻘﺎﺭﻨﺔ ﻤﻊ‬0.00) ‫( ﺫﺍﺕ ﻗﻴﻤﺔ ﻤﻌﻨﻭﻴﺔ‬122 ± 14.6) ‫( ﻋﻠﻰ ﺍﻝﺘﻭﺍﻝﻲ ﺒﻴﻨﻤﺎ ﻭﺠﺩﺕ ﺍﻝﺠﻠﺴﺭﻴﺩﺍﺕ ﺍﻝﺜﻼﺜﻴﺔ ﺒﻬﺎ ﺯﻴﺎﺩﺓ‬79.3±12.9)
‫ ﻭﻤﺴﺘﻭﻯ ﺘﺭﻜﻴﺯ‬T4‫ ﻭ‬T3 ‫ ﺃﻅﻬﺭﺕ ﺍﻝﺩﺭﺍﺴﺔ ﻭﺠﻭﺩ ﻋﻼﻗﺔ ﻋﻜﺴﻴﺔ ﺒﻴﻥ ﻫﺭﻤﻭﻨﺎﺕ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ‬.(67 ± 16.7) ‫ﺍﻝﻤﺠﻤﻭﻋﺔ ﺍﻝﻁﺒﻴﻌﻴﺔ‬
‫ ﺨﻠﺼﺕ ﺍﻝﺩﺭﺍﺴﺔ ﺍﻝﻰ ﺍﻥ ﻨﺸﺎﻁ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﻗﺩ ﺯﺍﺩ ﻤﻥ ﻤﺴﺘﻭﻴﺎﺕ ﻫﺭﻤﻭﻨﺎﺕ ﺍﻝﻐﺩﺓ ﺍﻝﺩﺭﻗﻴﺔ ﻭ ﺍﻝﺠﻠﺴﺭﻴﺩﺍﺕ‬.‫ﺍﻝﺩﻫﻭﻥ ﻓﻲ ﺍﻝﺒﻼﺯﻤﺎ‬
.‫ﺍﻝﺜﻼﺜﻴﺔ ﺒﻴﻨﻤﺎ ﻤﺴﺘﻭﻱ ﺍﻝﻜﻠﺴﺘﺭﻭل ﺍﻨﺨﻔﺽ‬

KEYWORDS: evert hyperthyroidism, high density lipoprotein, low density lipoprotein, Enzyme-
Linked Immunosorbent Assay (ELISA).

INTRODUCTION
Hyperthyroidism is a term for overactive However, information concerning lipid profile
tissue within the thyroid gland, resulting in is lacking or insufficient.
overproduction and thus an excess of MATERIALS and METHODS
circulating free thyroid hormones: thyroxin This study was conducted in Elobeid teaching
(T4), triiodothyronine (T3), or both (1). hospital, North Kordofan state; samples were
Human hyperthyroidism is accompanied by collected during the period from March 2011
multiple abnormalities with increased energy to March 2012 from patients who underwent
expenditure and excessive mobilization and routinely medical assessment by medical
utilization of metabolic substrates (2). doctors.
With respect to lipid metabolism it is clear that Blood samples were obtained from 150
the breakdown of triglycerides (TGs) stored in subjects 40 male and 110 female. Age of the
adipose tissue is enhanced by thyroid subjects ranged from 16 to 65 years, divided
hormones excess, resulting in concentration into two groups (100 new cases before starting
and turnover of non-esterified fatty acids the treatment and 50 with patients of
(NEFA) (3). This increased availability of fatty hyperthyroidism under treatment) beside 100
acids is associated with a rise in the lipid subjects as control subjects. All patients
oxidation rate (2). included in this study were proved to be
At the hepatic level this contributes to an hyperthyroidism (clinically and according to
elevated production rate of ketone bodies (3). laboratory diagnosis). Hypertensive patients,
Hyperthyroid patients have also low plasma diabetics, pregnant, smokers, obese, alcoholic,
cholesterol levels may be due to an increased those on lipid and contraceptive
biliary excretion of cholesterol (4). medications, and patients with renal and liver
However, hyperthyrodism was reported as diseases were excluded, because these factors
public health problem in Kordofan state. Most may affect the plasma lipid levels. Venous
of the studies done on thyroid patients directed blood samples were drawn after 8 to12 hours
to assess thyroid function (T3, T4). of overnight fasting. Blood samples were left
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Journal of Science and Technology Vol. 14 June /2013
ISSN -1605 – 427X
Natural and Medical Sciences (NMS No. 1)
mena@sustech.edu

to clot, after that; they were separated and kept mean age of new cases under treatment was
in two plain tubes. One sample was stored in 34.6±9.18 years ranging(15-65years), while
refrigerator at –20 ºC and later assayed to mean age of control persons was 33±7.6 years
determine (T3, T4, and TSH) in ranging (17-65) years. There was no
hyperthyroidism patients, using ELISA state significant difference between ages of the
fax 2100 with human regents. Another sample three groups. The results of the present study
used to measure lipids profile including; total that showed, approximate ratio of female to
cholesterol, triglycerides (TG), LDL-C, and male Sudanese hyperthyroidism was 2.75:1
HDL-C. These were measured by the with percentage of 73 % females and 27 %
Biosystem semi automated system using the males.
Biosystem diagnostic kits. Table (1) illustrates the findings of thyroid
Quality control: The precision and accuracy level in control subjects and patients suffering
of all methods used in this study were checked hyperthyroidism (new cases).
using commercially prepared control sera and T3 and T4 were significantly increased in new
results ±2SD were accepted. cases (3.9 ± 1.1) p-value <0.000) and
Statistical analysis (16.9±3.1 p-value <0.000) compared with
Computer software of Statistical Package for control group (1.08±0.4) and (8.07±1.6) for T3
Social Science (SPSS) version 17 was used for and T4, respectively.
data analysis. The mean and standard TSH on the other hand was significantly
deviation, Linear regression as well as, Chi- reduced (0.05 ± 0.06 p value <0.000)
square test with 95% confidence level were compared with control (2.6±0.17).
used. P value of less than or equal to 0.05 was Also the mean values of the total cholesterol,
considered statistically significant. high density lipoprotein cholesterol and low
RESULTS density lipoproteins cholesterol were
One hundred and fifty patients with thyroid significantly decreased, (107 ± 10.9 p-values <
disorder disease (divided into two groups, one 0.000), (46.6 ± 10.4 p-values <0.000), and
hundred subjected were new cases and fifty (35.6 ± 3.3 p-values <0.000) in comparison
subjected were Evert hyperthyroidism) were with control groups (154 ± 67), (52 ± 7.2) and
investigated for lipids profile. Moreover, one (79.3 ± 12.9), respectivly, while triglycerides
hundred control persons were subjected to the slightly increased (122 ± 14.6 p - value 0.00)
same investigations. compared with control group (67 ± 16.7).
In this study the mean ages of new cases were
36.6 ± 7.9 years ranging (16-65 years), and

Table 1: Biochemical parameters in control and new cases suffering from hyperthyroidism

Variables Control New Cases p-value

n = 100 n =100
Triiodotyronine (T3) (ng/ml) 1.08 ± 0.4 3.9 ± 1.1 0.00
Thyroxine (T4) ( µg/dl) 8.07 ±1.36 16.9 ±3.1 0.00
Thyroid stimulating hormone TSH( miu/l) 2.6 ±1.17 0.05 ± 0.06 0.00
Triglycerides (TG) (mg/dl) 67 ± 16.7 122 ± 14.6 0.00

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Journal of Science and Technology Vol. 14 June /2013
ISSN -1605 – 427X
Natural and Medical Sciences (NMS No. 1)
mena@sustech.edu

Total Cholesterol (mg/dl) 154.67 ±14.9 107.3 ± 10.9 0.00

High density lipoprotein (HDL) (mg/dl) 52 ±7.2 35.6 ± 3.3 0.00

Low density lipoprotein (LDL) (mg/dl) 79.3 ± 12.9 46.9 ± 10.4 0.00

● Results given in mean and ±SD were significantly decreased (131.98 ± 14.17
● P - value equal or less than 0.05 levels p-values <0.000), (45.04±5.43 p-values
considered significant <0.000), and (68.36 ± 12.76 p-values <0.039)
in comparison with control groups (154 ± 67),
Table (2) Shows the level of thyroid hormones (52 ± 7.2) and (79.3 ± 12.9), respectivly, while
and lipids in evert hyperthyroidism compared triglycerides slightly increased (91.98 ± 12.63
with control. No alteration of thyroid p – value 0.00) compared with the control
hormones level, (1.16 ± 0.42 p-value 0.272), group (67 ± 16.7). Table (3) shows a
(7.9 ± 0.94 p-value 0.663) and (2.25 ± 1.07 p- comparison of thyroid hormones and
value 0.061) was seen when compared with lipoprotein in females and males in new case
control group (1.08 ± 0.4), (8.07 ± 1.36) and of hyperthyroidism. Table (4) illustrates the
(2.6 ± 1.17) for T3, T4 and TSH, respectively. correlation between thyroid hormones and
Lipids, total cholesterol, HDL-C and LDL-C lipids profile in new hyperthyroidism patients.

Table 2: The level of thyroid hormones and lipids in evert hyperthyroidism compared with control

control Evert p-value

Variables n =100 hyperthyroidim
n =50
Triiodotyronine (T3) (ng/ml 1.08±0.4 1.16 ± 0.42 0.272
Thyroxine (T4) (µg/dl) 8.07±1.36 7.9 ± 0.94 0.663
Thyroid stimulating hormone TSH ( 2.6±1.17 2.25 ± 1.07 0.061
miu/l)
Triglycerides (TG) 67 +16.7 91.98 ± 12.63 0.00
Total Cholesterol (mg/dl) 154.67±14.9 131.98 ± 14.17 0.00
High density lipoprotein (HDL) 52±7.2 45.04 ± 5.43 0.00
(mg/dl)
Low density lipoprotein (LDL) 79.3 +12.9 68.36 ± 12.76 0.039
(mg/dl)

• Results are given in mean and ± SD.

• P.value equal to or less than 0.05 was considered significant.

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ISSN -1605 – 427X
Natural and Medical Sciences (NMS No. 1)
mena@sustech.edu

Table 3: Comparison of thyroid hormones and lipoprotein in females and males in new case of
hyperthyroidism

Variables Sex Mean p-value

Female 3.98 ± 1.17
T3 Male 3.87 ± 1.12 0.470
Female 17.53 ± 3.5
T4 Male 15.28 ±2.89 0.938
Female 0.053 ± 0.061
TSH Male 0.052±0.06 0.215
Female 47.8±10.6
LDL-C Male 46.0±10.1 0.070
Female 35.8±3.4
HDL-C Male 35.2±3. 0.606

Table 4: The correlation between thyroid hormones and lipids profile in new hyperthyroidism
patients

TC TAG HDL LDL

Variables r2 r2 r2 r2
T3 -0.524** +0.409** -.0365** -0.507**
T4 -0.243** +0.103** -0.141** -0.254**
TSH +0.05* -0.039* +0.050* +0.116**

**Correlation is significant at <0.01 level (2- r 2 = strength of correlation, (-) inversely

tailed). correlation, (+) proportional correlation.
*Correlation is significant at 0.05 levels (2-
tailed).

DISCUSSION
In this study, the prevalence of TSH) of the newly discovered group with
hyperthyroidism was more common in women controls group, resulting in p-value (<0.000,
than in men with a ratio of 2.75: 1 Showed <0.000 and <0.000) for the T3.T4 and TSH
low ratio when compared with previous respectively. In evert hyperthyroidism T3, T4
international study that reported and TSH were nor altered in comparison with
hyperthyroidism is generally affects females control p-values (0.272, 0.633 and 0.061) for
and males with a ratio of approximately 10:1 T3,T4 and TSH respectively. This finding is
respectively (5). This difference in the confirmed by previous study (6).
prevalence may result from immunological Our results showed that there was significant
changes that increase thyroid hormone levels. difference between mean concentration of
This study revealed that, there is significant lipids profile (Cholesterol, triglycerides, LDL-
difference when compare the mean C and HDL-C) of the new cases group with
concentration of thyroid hormones (T3, T4 and controls group. p-values (<0.000, <0.000,
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Journal of Science and Technology Vol. 14 June /2013
ISSN -1605 – 427X
Natural and Medical Sciences (NMS No. 1)
mena@sustech.edu

<0.000 and <0.000) for cholesterol, exchanges cholesteryl esters from HDL2 to the
triglycerides, LDL-C and HDL-C) very low density lipoproteins (VLDL) and
respectively. The presented results showed TGs to the opposite direction (13).
negative correlation between triiodthyronin Also our study showed that triglycerides (TGs)
(T3) and lipid levels (total Cholesterol, LDL-C of new cases (122 ± 14.6) were significantly
and HDL-C) (r2 0.524, 0.365 and 0.507) increased when compared with controls
respectively, while T3 had positive correlation subjects (67 ± 16.7, p-value < 0.000).
with the triglycerides (r2 0.409).On others The elevation of triglycerides (TGs) may be
hand TSH hormones had proportional due to breakdown of TGs stored in a dipose
correlation with total Cholesterol, LDL-C and tissue which is enhanced by thyroid hormones
HDL-C (0.05, 0.05 and 0.116, respectively. excess (3).
Both T4 and T3 can mediate thyroid hormone Our findings agreed with findings reported by
responses, T3 is more potent and binds the Esko, et al. 1972, where they found that in
thyroid hormone receptor with 15 fold greater thyrotoxicosis the mean triglyceride level was
affinity than T4 (7). slightly increased above that of control
The presented results also showed no subjects. Thyroid hormones control both
significant differences in the concentration of production and removal of plasma
(14)
LDL-C and HDL-C was observed between the triglycerides .
values of females and males for the new cases CONCLUSIONS
group with p-values = (0.07 and 0.606) for The present study concluded that, thyroid
LDL-C and HDL-C respectively dysfunction was more common among
The results of the present study showed that females than males. In addition,
total cholesterol, HDL-C and LDL in new Hyperthyroidism was associated with decrease
cases were decreased in hyperthyroidism in in total cholesterol, high density lipoprotein
comparison with control group. cholesterol, low density lipoprotein cholesterol
Our study agrees with studies conducted by and slightly increase in serum triglycerides
Cachefo, et al. 2001, Rizos, et al. 2011, and compared with control.
Nouh, et al. 2008, they found that
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