Effects on Metabolism and Energy Expenditure

As already mentioned, most of the effects of thyroid hormones (TH) are exerted on energy metabolism, including protein, carbohydrate, and lipid metabolism [18]. The stimulation of energy metabolism and heat production is reflected by the increased basal metabolic rate (BMR), increased appetite, heat intolerance and slightly elevated basal body temperature that occur during TS. Despite the increased food intake, a state of chronic caloric and nutritional inadequacy often ensues, depending on the degree of the TS-induced increase of metabolism.

Both the synthesis and the degradation of proteins are increased, the latter to a greater extent than the former, with the result that there is a net decrease in tissue proteins, as indicated by negative nitrogen balance, weight loss, muscle wasting, weakness, and mild hypoalbuminaemia [18].

As regards glucose metabolism, increased insulin resistance is common in TS and pre-existing diabetes is commonly aggravated by TS.

Both the synthesis and the degradation of triglycerides and cholesterol are increased in TS, but the net effect is one of lipid degradation, as reflected by an increase in the plasma concentrations of free fatty acids and glycerol, and the decrease of serum cholesterol level. Serum triglyceride levels are usually slightly decreased [18].

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