Mustafa Yontem, Serap Arslan, Behic Selman Erdogdu, Fatma Emel Kocak


Background: Overproduction of oxygen-related free radicals and inadequate antioxidant defense are critical in hypothyroidism, as they might lead to future life-threatening diseases. The objectives of this study were to compare serum levels of oxidative stress markers; total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase-1 (PON-1), and arylesterase (ARYL) in patients with subclinical hypothyroidism (SH) and overt hypothyroidism (OH) versus healthy controls in population of Kutahya city, Turkey.

Materials & Methods: This cross-sectional study was conducted at Department of Biochemistry, Faculty of Medicine, Kutahya University of Health Sciences, Kutahya, Turkey, from July to December, 2016. Three study groups of 45 each were formed as healthy controls, patients with SH and OH. Serum levels of TOS, TAS, OSI, PON-1, and ARYL were five research variables with ratio scale, but skewed, so described by median and IQR with 95% Cl. Kruskal-Wallis and multiple comparison tests were used for hypotheses testing.

Results: Serum levels of TOS and OSI were higher in SH group (p-values 0.032; <.0001; respectively) and OH group (p-values <.0001; <.0001, respectively) than healthy controls, while serum levels of TAS, PON-1 and ARYL were lower in SH group (p-values <.0001; <.0001; <.0001, respectively) and OH group (p-values <.0001; <.0001; <.0001, respectively) than control group.

Conclusion: Our study showed that serum levels of TOS and OSI were higher in subclinical and overt hypothyroidism than in healthy controls; while serum levels of TAS, PON-1, and ARYL were lower in subclinical and overt hypothyroidism than in healthy controls.


Hypothyroidism; Thyroid Stimulating Hormone; Oxidants; Antioxidants; Oxidative Stress; Paraoxonase-1; Total Oxidant Status; Total Antioxidant Status; Oxidative Stress Index; Arylesterase.

Full Text:



Biondi B, Cappola AR, Cooper DS. Subclinical hypothyroidism: a review. JAMA 2019;322:153-60.

Zha K, Zuo C, Wang A, Zhang B, Zhang Y, Wang B, et al. LDL in patients with subclinical hypothyroidism shows increased lipid peroxidation. Lipids Health Dis 2015;14:95.

O"Brien T, Dinneen SF, O"Brien PC, Palumbo PJ. Hyperlipidemia in patients with primary and secondary hypothyroidism. Mayo Clin Proc 1993;68:860-6.

Rizos C V, Elisaf MS, Liberopoulos EN. Effects of thyroid dysfunction on lipid profile. Open Cardiovasc Med J 2011;5:76-84.

Milionis HJ, Tambaki AP, Kanioglou CN, Elisaf MS, Tselepis AD, Tsatsoulis A. Thyroid substitution therapy induces high-density lipoprotein-associated platelet- activating factor-acetylhydrolase in patients with subclinical hypothyroidism: a potential antiatherogenic effect. Thyroid 2005;15:455-60.

Toruner F, Altinova AE, Karakoc A, Yetkin I, Ayvaz G, Cakir N, et al. Risk factors for cardiovascular disease in patients with subclinical hypothyroidism. Adv Ther 2008;25:430.

Ates I, Yilmaz FM, Altay M, Yilmaz N, Berker D, Güler S. The relationship between oxidative stress and autoimmunity in Hashimoto"s thyroiditis. Eur J Endocrinol 2015;173(6):791-9.

Torun AN, Kulaksizoglu S, Kulaksizoglu M, Pamuk BO, Isbilen E, Tutuncu NB. Serum total antioxidant status and lipid peroxidation marker malondialdehyde levels in overt and subclinical hypothyroidism. Clin Endocrinol (Oxf) 2009;70:469-74.

Pereira B, Rosa LC, Safi DA, Bechara EJH, Curi R. Control of superoxide dismutase, catalase and glutathione peroxidase activities in rat lymphoid organs by thyroid hormones. J Endocrinol 1994;140:73-7.

Swaroop A, Ramasarma T. Heat exposure and hypothyroid conditions decrease hydrogen peroxide generation in liver mitochondria. Biochem J 1985;226:403-8.

Yilmaz S, Ozan S, Benzer F, Canatan H. Oxidative damage and antioxidant enzyme activities in experimental hypothyroidism. Cell Biochem Funct 2003;21(4):325-30.

Dumitriu L, Bartoc R, Ursu H, Purice M, Ionescu V. Significance of high levels of serum malonyl dialdehyde (MDA) and ceruloplasmin (CP) in hyper-and hypothyroidism. Endocrinologie 1988;26:35-8.

Costantini F, Pierdomenico SD, Cesare D De, De Remigis P, Bucciarelli T, Bittolo- Bon G, et al. Effect of thyroid function on LDL oxidation. Arterioscler Thromb Vasc Biol 1998;18:732-7.

Bacchetti T, Ferretti G, Sahebkar A. The role of paraoxonase in cancer. Semi Cancer Biol 2019; 56:72-86.

Aviram M, Rosenblat M, Bisgaier CL, Newton RS, Primo-Parmo SL, La Du BN. Paraoxonase inhibits high-density lipoprotein oxidation and preserves its functions. A possible peroxidative role for paraoxonase. J Clin Invest 1998;101:1581-90

Mackness MI. "A"-esterases: Enzymes looking for a role? Biochem Pharmacol 1989;38:385-90.

Gan KN, Smolen A, Eckerson HW, La Du BN. Purification of human serum paraoxonase/arylesterase. Evidence for one esterase catalyzing both activities. Drug Metab Dispos 1991;19:100-6.

Baskol G, Atmaca H, Tanrıverdi F, Baskol M, Kocer D, Bayram F. Oxidative stress and enzymatic antioxidant status in patients with hypothyroidism before and after treatment. Exp Clin Endocrinol Diabetes 2007;115:522-6.

Ayub A, Mackness MI, Arrol S, Mackness B, Patel J, Durrington PN. Serum paraoxonase after myocardial infarction. Arterioscler Thromb Vasc Biol 1999;19:330-5.

Mackness MI, Harty D, Bhatnagar D, Winocour PH, Arrol S, Ishola M, et al. Serum paraoxonase activity in familial hypercholesterolaemia and insulin-dependent diabetes mellitus. Atherosclerosis 1991;86:193-9.

Sahin M, Bobusoglu O, Yetim A, Ates F. Paraoxonase-1 and arylesterase levels in patients with ulcerative colitis. Arab J Gastroenterol 2019;20:14-8.

Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin Biochem 2004;37:112-9.

Erel O. A new automated colorimetric method for measuring total oxidant status. Clin Biochem 2005;38:1103-11.

Akcilar R, Akcilar A, Savran B, Ayada C, Koçak C, Koçak FE, et al. Effects of ukrain in rats with intestinal ischemia and reperfusion. J Surg Research 2015;195(1):67-73.

Eckerson HW, Wyte CM, La Du BN. The human serum paraoxonase/arylesterase polymorphism. Am J Hum Genet 1983;35(6):1126-38.

Ates I, Altay M, Yilmaz FM, Topcuoglu C, Yilmaz N, Guler S. Is oxidative stress an effective risk factor in the development of overt hypothyroidism in Hashimoto"s thyroiditis. In 17th European Congress of Endocrinology 2015; vol. 37, BioScientifica.

Ates I, Altay M, Yılmaz FM, Topçuoğlu C, Yılmaz N, Berker D, et al. The impact of levothyroxine sodium treatment on oxidative stress in Hashimoto"s thyroiditis. Eur J Endocrinol 2016;174(6):727-34.

Aydogdu A, Karakas EY, Erkus E, Altıparmak İH, Savık E, Ulas T, et al. Epicardial fat thickness and oxidative stress parameters in patients with subclinical hypothyroidism. Arch Med Sci 2017;13(2):383-9.

Cebeci E, Alibaz-Oner F, Usta M, Yurdakul S, Erguney M. Evaluation of oxidative stress, the activities of paraoxonase and arylesterase in patients with subclinical hypothyroidism. J Investig Med 2012;60:23-8.

Santi A, Duarte MM, de Menezes CC, Loro VL. Association of lipids with oxidative stress biomarkers in subclinical hypothyroidism. Int J Endocrinol 2012;2012:856359.



  • There are currently no refbacks.

Copyright (c) 2021. Mustafa Yontem, Serap Arslan, Behic Selman Erdogdu, Fatma Emel Kocak

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.