Cardiovascular Risk Determinants in Euthyroid Patients with Obesity: The Strange Case of TSH in Primary Prevention

Background: Thyrotropin (TSH), even in the normal range, is associated with components of cardiometabolic syndrome. We aimed to assess the relation between TSH and cardiovascular (CV) risk in euthyroid patients with overweight/obesity without previous cardiac events. Methods: A total of 1588 subjects (1132 females, mean age 53 ± 14 years) were recruited. This was an observational study. TSH, body mass index, waist circumference (WC), creatinine, hepatic enzymes, homocysteine, C reactive protein, glycated hemoglobin, homeostatic model assessment for insulin resistance (HOMA-IR), basal and 2 h glucose and insulin, fibrinogen, uric acid, a complete blood count, a complete lipid profile, and blood pressure were measured in all subjects. The Atherosclerotic Cardiovascular Disease (ASCVD) risk score was calculated. Results: More severe degrees of obesity were associated with higher TSH quartiles; specifically, 33% of subjects with grade III obesity had TSH in the 75th percentile. Multiple regression showed that female gender (t-value 3.6, p < 0.001), HOMA-IR (1.9, ≤0.05) and aspartate transaminase (AST; 2.8, 7.5%; n = 709). Similarly, TSH determinants in subjects with central obesity (n = 1197, WC >102 cm males, >88 cm females) were female gender (2.2,