Brown Adipose Tissue Activity and Thyroid Hormone
Study Details
Study Description
Brief Summary
Rationale: During the last decades, research in possible therapies for existing obesity and developmental factors causing obesity has explosively increased. Recently renewed interest aroused for a tissue playing a possible role in both development and therapy for obesity: brown adipose tissue (BAT).
To define the relation between BAT and thyroid hormone, the investigators set up the following research protocol. In this protocol BAT activity will be determined in subjects that underwent thyroidectomy for well-differentiated thyroid carcinoma.
Objective: To study the effect of thyroid hormone and thyroid-stimulating hormone on brown adipose tissue activity.
Study design: Determine BAT activity after thyroidectomy in well-differentiated thyroid carcinoma patients.
Study population: Patients that underwent thyroidectomy for well-differentiated thyroid carcinoma, male and female, aged 18-65 years.
Intervention: FDG-PET-CT-imaging ([18F]fluorodeoxyglucose positron-emission-tomography computed-tomography) of BAT activity will be performed under cold stimulation twice.
For patients clinically withdrawn from thyroid hormone suppletion, the first occasion will be in a hypothyroid state within 4-6 weeks after thyroidectomy and the second measurement will take place in a euthyroid state 4 months after the start of thyroid hormone treatment.
For patients receiving recombinant-thyroid-stimulating-hormone injections, the first occasion will be shortly after the injection in a state of high thyroid-stimulating hormone levels. The second measurement will be in a euthyroid state 4 months after the injection.
Main study parameters/endpoints: The main endpoint of this study is the effect of thyroid hormone and thyroid-stimulating hormone on BAT activity in kBq (kilobecquerel) and SUV (standard uptake value). Secondary endpoints are the effects of thyroid hormone and thyroid-stimulating hormone on energy metabolism, body core temperature, skin surface temperatures and skin perfusion.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The absorbed radiation dose from the FDG PET-CT scan after administration of 74 MBq (megabecquerel) of 18F-FDG is 2.8 mSv (miliSievert).
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Other: Before levothyroxine therapy 137.75 μg 18F-FDG PET CT scan after mild cold exposure 6.8 ± 2.8 weeks after thyroidectomy, when plasma free T4-levels were at the minimum, before daily levothyroxine therapy 137.75 ± 25.75 μg. |
Other: Levothyroxine therapy (137.75 ± 23.75 μg/day)
This study was a longitudinal study in an academic center, with a follow-up period of 6 months. Ten patients with well-differentiated thyroid carcinoma eligible for surgical treatment and subsequent radioactive iodine ablation therapy were studied in a hypothyroid state after thyroidectomy and in a subclinical hyperthyroid state (TSH-suppression according to standard treatment protocol).
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| Other: After levothyroxine therapy 137.75 μg 18F-FDG PET CT scan after mild cold exposure four to six months after the initial measurements, after daily levothyroxine therapy 137.75 μg (fT4 levels 23.1 ± 3.9 pmol/L, TSH 0.5 ± 0.6 mU/L) |
Other: Levothyroxine therapy (137.75 ± 23.75 μg/day)
This study was a longitudinal study in an academic center, with a follow-up period of 6 months. Ten patients with well-differentiated thyroid carcinoma eligible for surgical treatment and subsequent radioactive iodine ablation therapy were studied in a hypothyroid state after thyroidectomy and in a subclinical hyperthyroid state (TSH-suppression according to standard treatment protocol).
|
Outcome Measures
Primary Outcome Measures
- Cold-induced brown adipose tissue activity [1 day]
Measured with 18FDG PET/CT scan after personalised cooling protocol
Secondary Outcome Measures
- Energy expenditure [1 day]
Energy expenditure measured with ventilated hood system
- Body core temperature [1 day]
Body core temperature measured with CorTemp telemetric pill
- Skin temperatures [1 day]
Skin temperatures measured with iButton wireless dataloggers at 14 ISO-defined positions on the skin
- Skin perfusion [1 day]
Skin perfusion measured with laser-doppler flowmetry on hand and forearm
Eligibility Criteria
Criteria
Inclusion Criteria:
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Male or postmenopausal females undergoing a total thyroidectomy for well-differentiated thyroid carcinoma
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Age 18-65 years
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Stable physical activity levels for at least six months
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Note: In case of use of anticoagulation, the dose will be adjusted according to plasma thyroid hormone values.
Exclusion Criteria:
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Psychologically unstable subjects (as judged by the treating medical specialist)
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Subjects with mental retardation (as judged by the treating medical specialist)
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Subjects with severe behavior disorders (as judged by the treating medical specialist)
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Pregnant subjects
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The use of the following medication is an exclusion criterium; ß-blockers
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Participation in an intensive weight-loss program or vigorous exercise program during the last year before the start of the study
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Abuse of drugs and/or alcohol
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Severe diabetes which requires application of insulin or patients with diabetes-related complications
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Maastricht UMC | Maastricht | Limburg | Netherlands | 6229HX |
Sponsors and Collaborators
- Maastricht University Medical Center
Investigators
- Principal Investigator: Wouter van Marken Lichtenbelt, Professor, Maastricht University Medical Center
Study Documents (Full-Text)
None provided.More Information
Publications
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- Bianco AC, Salvatore D, Gereben B, Berry MJ, Larsen PR. Biochemistry, cellular and molecular biology, and physiological roles of the iodothyronine selenodeiodinases. Endocr Rev. 2002 Feb;23(1):38-89. Review.
- Cannon B, Nedergaard J. Brown adipose tissue: function and physiological significance. Physiol Rev. 2004 Jan;84(1):277-359. Review.
- de Jesus LA, Carvalho SD, Ribeiro MO, Schneider M, Kim SW, Harney JW, Larsen PR, Bianco AC. The type 2 iodothyronine deiodinase is essential for adaptive thermogenesis in brown adipose tissue. J Clin Invest. 2001 Nov;108(9):1379-85.
- Endo T, Kobayashi T. Thyroid-stimulating hormone receptor in brown adipose tissue is involved in the regulation of thermogenesis. Am J Physiol Endocrinol Metab. 2008 Aug;295(2):E514-8. doi: 10.1152/ajpendo.90433.2008. Epub 2008 Jun 17.
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- Kingma BR, Frijns AJ, Saris WH, van Steenhoven AA, Lichtenbelt WD. Increased systolic blood pressure after mild cold and rewarming: relation to cold-induced thermogenesis and age. Acta Physiol (Oxf). 2011 Dec;203(4):419-27. doi: 10.1111/j.1748-1716.2011.02336.x. Epub 2011 Aug 12.
- Lahesmaa M, Orava J, Schalin-Jäntti C, Soinio M, Hannukainen JC, Noponen T, Kirjavainen A, Iida H, Kudomi N, Enerbäck S, Virtanen KA, Nuutila P. Hyperthyroidism increases brown fat metabolism in humans. J Clin Endocrinol Metab. 2014 Jan;99(1):E28-35. doi: 10.1210/jc.2013-2312. Epub 2013 Dec 20.
- Lee JY, Takahashi N, Yasubuchi M, Kim YI, Hashizaki H, Kim MJ, Sakamoto T, Goto T, Kawada T. Triiodothyronine induces UCP-1 expression and mitochondrial biogenesis in human adipocytes. Am J Physiol Cell Physiol. 2012 Jan 15;302(2):C463-72. doi: 10.1152/ajpcell.00010.2011. Epub 2011 Nov 9.
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- Louzada RA, Santos MC, Cavalcanti-de-Albuquerque JP, Rangel IF, Ferreira AC, Galina A, Werneck-de-Castro JP, Carvalho DP. Type 2 iodothyronine deiodinase is upregulated in rat slow- and fast-twitch skeletal muscle during cold exposure. Am J Physiol Endocrinol Metab. 2014 Dec 1;307(11):E1020-9. doi: 10.1152/ajpendo.00637.2013. Epub 2014 Oct 7.
- Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45. Review. Erratum in: JAMA. 2005 Jan 19;293(3):298. Erratum in: JAMA. 2005 Jan 19;293(3):293-4.
- Orava J, Nuutila P, Lidell ME, Oikonen V, Noponen T, Viljanen T, Scheinin M, Taittonen M, Niemi T, Enerbäck S, Virtanen KA. Different metabolic responses of human brown adipose tissue to activation by cold and insulin. Cell Metab. 2011 Aug 3;14(2):272-9. doi: 10.1016/j.cmet.2011.06.012.
- Saito M, Okamatsu-Ogura Y, Matsushita M, Watanabe K, Yoneshiro T, Nio-Kobayashi J, Iwanaga T, Miyagawa M, Kameya T, Nakada K, Kawai Y, Tsujisaki M. High incidence of metabolically active brown adipose tissue in healthy adult humans: effects of cold exposure and adiposity. Diabetes. 2009 Jul;58(7):1526-31. doi: 10.2337/db09-0530. Epub 2009 Apr 28.
- TATA JR, ERNSTER L, LINDBERG O. Control of basal metabolic rate by thyroid hormones and cellular function. Nature. 1962 Mar 17;193:1058-60.
- van der Lans AA, Hoeks J, Brans B, Vijgen GH, Visser MG, Vosselman MJ, Hansen J, Jörgensen JA, Wu J, Mottaghy FM, Schrauwen P, van Marken Lichtenbelt WD. Cold acclimation recruits human brown fat and increases nonshivering thermogenesis. J Clin Invest. 2013 Aug;123(8):3395-403. doi: 10.1172/JCI68993. Epub 2013 Jul 15.
- van Marken Lichtenbelt WD, Daanen HA, Wouters L, Fronczek R, Raymann RJ, Severens NM, Van Someren EJ. Evaluation of wireless determination of skin temperature using iButtons. Physiol Behav. 2006 Jul 30;88(4-5):489-97. Epub 2006 Jun 23.
- van Marken Lichtenbelt WD, Vanhommerig JW, Smulders NM, Drossaerts JM, Kemerink GJ, Bouvy ND, Schrauwen P, Teule GJ. Cold-activated brown adipose tissue in healthy men. N Engl J Med. 2009 Apr 9;360(15):1500-8. doi: 10.1056/NEJMoa0808718. Erratum in: N Engl J Med. 2009 Apr 30;360(18):1917.
- Virtanen KA, Lidell ME, Orava J, Heglind M, Westergren R, Niemi T, Taittonen M, Laine J, Savisto NJ, Enerbäck S, Nuutila P. Functional brown adipose tissue in healthy adults. N Engl J Med. 2009 Apr 9;360(15):1518-25. doi: 10.1056/NEJMoa0808949. Erratum in: N Engl J Med. 2009 Sep 10;361(11):1123.
- Vosselman MJ, van der Lans AA, Brans B, Wierts R, van Baak MA, Schrauwen P, van Marken Lichtenbelt WD. Systemic β-adrenergic stimulation of thermogenesis is not accompanied by brown adipose tissue activity in humans. Diabetes. 2012 Dec;61(12):3106-13. doi: 10.2337/db12-0288. Epub 2012 Aug 7.
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