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Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis

Year 2016, , 213 - 8, 15.05.2016

Ethem Cerit , Mujde Akturk

https://doi.org/10.17546/msd.31690

Abstract

Hypothyroidism is the condition of decreased hormone production to provide the needs of peripheral tissues. Clinical symptoms may vary depending on patient's age, disease duration and thyroid hormone levels. Thyroid hormones are important determinants of basal metabolic rate and thyroid hormone status have a strong effect on different metabolic pathways (protein, carbohydrate, lipid) and atherosclerotic pathogenetic mechanisms.

This review focuses on metabolic and atherosclerotic effects of hypothyroidism due to chronic (hashimoto) thyroiditis

Keywords

hypothyroidism; basal metabolism; body composition; atherosclerosis

References

  • Ross DS. Thyroid hormone synthesis and physiology Uptodate. Jun 2013. Avaliable form URL: http://www.uptodate.com/contents/thyroid-hormone-synthesis-and-physiology
  • Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol 1995; 43(1): 55-68.
  • Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990; 71(3): 661-9.
  • Lopez M, Alvarez CV, Nogueiras R, Dieguez C. Energy balance regulation by thyroid hormones at central level. Trends Mol Med 2013; 19(7): 418-27.
  • Gjedde S, Gormsen LC, Riis AL, Jorgensen JO, Rungby J, Moller N, et al. Reduced expression of uncoupling protein 2 in adipose tissue in patients with hypothyroidism. J Clin Endocrinol Metab 2010; 95: 3537-41.
  • Ockenga J, Valentini L, Schuetz T, Wohlgemuth F, Glaeser S, Omar A, et al. Plasma bile acids are associated with energy expenditure and thyroid function in humans. J Clin Endocrinol Metab 2012; 97(2): 535-42.
  • Knudsen N, Laurberg P, RasmussenLB, Bulow I, Perrild H, Ovesen L, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 2005; 90: 4019–24.
  • Fox CS, Pencina MJ, D'Agostino RB, Murabito JM, Seely EW, Pearce EN, et al. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med 2008; 168(6): 587-92.
  • De Moura Souza A, Sichieri R. Association between serum TSH concentration within the normal range and adiposity. Eur J Endocrinol 2011; 165(1): 11-5.
  • Svare A, Nilsen TI, Bjoro T, Asvold BO, Langhammer A. Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway. Clin Endocrinol 2011; 74(6): 769-75.
  • Westerink J, van der Graaf Y, Faber DR, Visseren FL. The relation between thyroid-stimulating hormone and measures of adiposity in patients with manifest vascular disease.; SMART study group. Eur J Clin Invest 2011; 41(2): 159-66.
  • Hoogwerf BJ, Nuttall FQ. Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984; 76(6): 963-70.
  • Brunova J, Kasalicky P, Lansk V. The assessment of body composition using DEXA in patients with thyroid dysfunction. Cas Lek Cesk 2007; 146(5): 497-502.
  • Karmisholt J, Andersen S, Laurberg P. Weight loss after therapy of hypothyroidism is mainly caused by excretion of excess body water associated with myxoedema. J Clin Endocrinol Metab 2011; 96: 99 –103.
  • Cerit ET, Akturk M, Altinova AE, Tavil Y, Ozkan C, Yayla C, Altay M, Demirtas C, Cakir N., Evaluation of body composition changes, epicardial adipose tissue, and serum omentin-1 levels in overt hypothyroidism. Endocrine. 2015 May;49(1):196-203.
  • Lewallen CG, Rall JE, Berman M. Studies of iodoalbumin metabolism. The effects of thyroid hormone. J Clin Invest 1959; 38: 88-101.
  • Smith TJ, Murata Y, Horwitz AL, Philipson L, Refetoff S. Regulation of glycosaminoglycan accumulation by thyroid hormone in vitro. J Clin Invest 1982; 70: 1066-73.
  • Crispell KR, Parson W, Hollifield G. A study of the rate of protein synthesis before and during the administration of L-triiodothyronine to patients with myxedema and healthy volunteers using N-15 glycine. J Clin Invest 1956; 35: 164-9.
  • Lamberg BA, Grasbeck R. The serum protein pattern in disorders of thyroid function. Acta Endocrinol 1955; 19: 91-100.
  • Krassas GE, Pontikides N, Loustis K, Koliakos G, Constantinidis T, Kaltsas T. Resistin levels are normal in hypothyroidism and remain unchanged after attainment of euthyroidism: relationship with insulin levels and anthropometric parameters. J Endocrinol Invest 2006; 29: 606-12.
  • Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 2006; 91: 4930-7.
  • Brauman H, Corvilain J. Growth hormone response to hypoglycemia in myxedema. J Clin Endocrinol Metab 1968; 28: 301-4.
  • Shah JH, Motto GS, Papagiannes E, William GA. Insulin metabolism in hypothyroidism. Diabetes 1975; 24: 922-5.
  • Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol 2009; 160: 785-90.
  • Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999; 22: 1462-70.
  • Gimenez-Palop O, Gimenez-Perez G, Mauricio D, Berlanga E, Potau N, Vilardell C, et al. Circulating ghrelin in thyroid dysfunction is related to insulin resistance and not to hunger, food intake or anthropometric changes. Eur J Endocrinol 2005; 153: 73-79.
  • Erdogan M, Canataroglu A, Ganidagli S, Kulaksizoglu M. Metabolic syndrome prevalence in subclinic and overt hypothyroid patients and the relation among metabolic syndrome parameters. J Endocrinol Invest 2011; 34(7): 488-92.
  • Handisurya A, Pacini G, Tura A, Gessi A, Kautzky-Willer A. Effects of T4-replacement therapy on glucose metabolism in subjects with subclinical and overt hypothyroidism. Clin Endocrinol 2008; 69: 963-69.
  • Scarabottolo L, Trezzi E, Roma P, Gatapano AL. Experimental hypothyroidism modulates the expression of the low density lipoprotein receptor by the liver. Atherosclerosis 1986; 59: 329-33.
  • Diekman T, Demacker PN, Kastelein JJ, Stalenhoef AF, Wiersinga WM. Increased oxidizability of low-density lipoproteins in hypothyroidism. J Clin Endocrinol Metab 1998; 83: 1752-55.
  • O'Brien T, Katz K, Hodge D, Nguyen TT, Kottke BA, Hay ID. The effect of treatment of hypothyroidism and hyperthyroidism on plasma lipids and apolipoproteins AI, AII and E. Clin Endocrinol 1997; 46: 17-20.
  • Tanaci N, Ertugrul DT, Sahin M, Yucel M, Olcay I, Demirag NG, et al. Postprandial lipemia as a risk factor for cardiovascular disease in patients with hypothyroidism. Endocrine 2006; 29: 451-56.
  • Gjedde S, Gormsen LC, Rungby J, Nielsen S, Jorgensen JO, Pedersen SB et al. Decreased lipid intermediate levels and lipid oxidation rates despite normal lipolysis in patients with hypothyroidism. Thyroid 2010; 20: 843-49.
  • Martinez-Triguero ML, Hernandez-Mijares A, Nguyen TT, Munoz ML, Pena H, Morillas C, et al. Effect of thyroid hormone replacement on lipoprotein (a), lipids, and apolipoproteins in subjects with hypothyroidism. Mayo Clin Proc 1998; 73: 837-41.
  • Tzotzas T, Krassas GE, Konstantinidis T, Bougoulia M. Changes in lipoprotein(a) levels in overt and subclinical hypothyroidism before and during treatment. Thyroid 2000; 10(9): 803-8.
  • Spandrio S, Sleiman I, Scalvini T, Salvi A, Di Stefano O, Pagliaini R, et al. Lipoprotein (a) in thyroid dysfunction before and after treatment. Horm Metab Res 1993; 25(11): 586-9.
  • Pearce EN, Wilson PW, Yang Q, Vasan RS, Braverman LE. Thyroid function and lipid subparticle sizes in patients with short-term hypothyroidism and a population-based cohort. J Clin Endocrinol Metab 2008; 93: 888-94.
  • Goede DL, Wiesli P, Brandle M, Bestmann L, Bernays RL, Zwimpfer C, Schmid C, et al. Effects of thyroxine replacement on serum creatinine and cystatin C in patients with primary and central hypothyroidism. Swiss Med Wkly 2009; 139: 339-44.
  • Hanna FWF, Scanlon MF. Hyponatraemia, hypothyroidism and role of arginine-vasopressin. Lancet 1997; 350: 755-56.
  • Leeper RD, Benua RS, Brener JL, Rawson RW. Hyperuricemia in myxedema. J Clin Endocrinol Metab 1960; 20: 1457-66.
  • Jones JE, Desper PC, Shane SR, Flink EB. Magnesium metabolism in hyperthyroidism and hypothyroidism. J Clin Invest 1966; 45: 891-900.
  • Iglesias P, Diez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol 2009; 160: 503-15.
  • Kilein I, Danzi S. Thyroid disease and the heart. Circulation 2007; 116: 1725-35.
  • Dernellis J, Panaretou M. Effects of thyroid replacement therapy on arterial blood pressure in patients with hypertension and hypothyroidism. Am Heart J 2002; 143: 718-24.
  • Hardisty CA, Naik DR, Munro DS. Pericardial effusion in hypothyroidism. Clin Endocrinol 1980; 13: 349-54.
  • Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003; 88: 2438-44.
  • Diekman MJM, Put NM, Blom HJ, Tijssen JGP, Wiersinga WM. Determinants of changes in plasma homocysteine in hyperthyroidism and hypothyroidism. Clin Endocrinol 2001; 54: 197-204.
  • Ito M, Arishima T, Kudo T, Nishihara E, Ohye H, Kubota S, et al. Effect of levothyroxine replacement on non-high-density lipoprotein cholesterol in hypothyroid patients. J Clin Endocrinol Metab 2007; 92: 608-11.
  • Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam study. Ann Int Med 2000; 132: 270-78.
  • Asik M, Sahin S, Ozkul F, Anaforoglu I, Ayhan S, Karagol S, Gunes F, Algun E. Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis. Clin Endocrinol (Oxf). 2013 Oct;79(4):571-6. doi: 10.1111/cen.12176. Epub 2013 May 20.

Year 2016, , 213 - 8, 15.05.2016

Ethem Cerit , Mujde Akturk

https://doi.org/10.17546/msd.31690

Abstract

References

  • Ross DS. Thyroid hormone synthesis and physiology Uptodate. Jun 2013. Avaliable form URL: http://www.uptodate.com/contents/thyroid-hormone-synthesis-and-physiology
  • Vanderpump MP, Tunbridge WM, French JM, Appleton D, Bates D, Clark F, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol 1995; 43(1): 55-68.
  • Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab 1990; 71(3): 661-9.
  • Lopez M, Alvarez CV, Nogueiras R, Dieguez C. Energy balance regulation by thyroid hormones at central level. Trends Mol Med 2013; 19(7): 418-27.
  • Gjedde S, Gormsen LC, Riis AL, Jorgensen JO, Rungby J, Moller N, et al. Reduced expression of uncoupling protein 2 in adipose tissue in patients with hypothyroidism. J Clin Endocrinol Metab 2010; 95: 3537-41.
  • Ockenga J, Valentini L, Schuetz T, Wohlgemuth F, Glaeser S, Omar A, et al. Plasma bile acids are associated with energy expenditure and thyroid function in humans. J Clin Endocrinol Metab 2012; 97(2): 535-42.
  • Knudsen N, Laurberg P, RasmussenLB, Bulow I, Perrild H, Ovesen L, et al. Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population. J Clin Endocrinol Metab 2005; 90: 4019–24.
  • Fox CS, Pencina MJ, D'Agostino RB, Murabito JM, Seely EW, Pearce EN, et al. Relations of thyroid function to body weight: cross-sectional and longitudinal observations in a community-based sample. Arch Intern Med 2008; 168(6): 587-92.
  • De Moura Souza A, Sichieri R. Association between serum TSH concentration within the normal range and adiposity. Eur J Endocrinol 2011; 165(1): 11-5.
  • Svare A, Nilsen TI, Bjoro T, Asvold BO, Langhammer A. Serum TSH related to measures of body mass: longitudinal data from the HUNT Study, Norway. Clin Endocrinol 2011; 74(6): 769-75.
  • Westerink J, van der Graaf Y, Faber DR, Visseren FL. The relation between thyroid-stimulating hormone and measures of adiposity in patients with manifest vascular disease.; SMART study group. Eur J Clin Invest 2011; 41(2): 159-66.
  • Hoogwerf BJ, Nuttall FQ. Long-term weight regulation in treated hyperthyroid and hypothyroid subjects. Am J Med 1984; 76(6): 963-70.
  • Brunova J, Kasalicky P, Lansk V. The assessment of body composition using DEXA in patients with thyroid dysfunction. Cas Lek Cesk 2007; 146(5): 497-502.
  • Karmisholt J, Andersen S, Laurberg P. Weight loss after therapy of hypothyroidism is mainly caused by excretion of excess body water associated with myxoedema. J Clin Endocrinol Metab 2011; 96: 99 –103.
  • Cerit ET, Akturk M, Altinova AE, Tavil Y, Ozkan C, Yayla C, Altay M, Demirtas C, Cakir N., Evaluation of body composition changes, epicardial adipose tissue, and serum omentin-1 levels in overt hypothyroidism. Endocrine. 2015 May;49(1):196-203.
  • Lewallen CG, Rall JE, Berman M. Studies of iodoalbumin metabolism. The effects of thyroid hormone. J Clin Invest 1959; 38: 88-101.
  • Smith TJ, Murata Y, Horwitz AL, Philipson L, Refetoff S. Regulation of glycosaminoglycan accumulation by thyroid hormone in vitro. J Clin Invest 1982; 70: 1066-73.
  • Crispell KR, Parson W, Hollifield G. A study of the rate of protein synthesis before and during the administration of L-triiodothyronine to patients with myxedema and healthy volunteers using N-15 glycine. J Clin Invest 1956; 35: 164-9.
  • Lamberg BA, Grasbeck R. The serum protein pattern in disorders of thyroid function. Acta Endocrinol 1955; 19: 91-100.
  • Krassas GE, Pontikides N, Loustis K, Koliakos G, Constantinidis T, Kaltsas T. Resistin levels are normal in hypothyroidism and remain unchanged after attainment of euthyroidism: relationship with insulin levels and anthropometric parameters. J Endocrinol Invest 2006; 29: 606-12.
  • Dimitriadis G, Mitrou P, Lambadiari V, Boutati E, Maratou E, Panagiotakos DB, et al. Insulin action in adipose tissue and muscle in hypothyroidism. J Clin Endocrinol Metab 2006; 91: 4930-7.
  • Brauman H, Corvilain J. Growth hormone response to hypoglycemia in myxedema. J Clin Endocrinol Metab 1968; 28: 301-4.
  • Shah JH, Motto GS, Papagiannes E, William GA. Insulin metabolism in hypothyroidism. Diabetes 1975; 24: 922-5.
  • Maratou E, Hadjidakis DJ, Kollias A, Tsegka K, Peppa M, Alevizaki M, et al. Studies of insulin resistance in patients with clinical and subclinical hypothyroidism. Eur J Endocrinol 2009; 160: 785-90.
  • Matsuda M, DeFronzo RA. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care 1999; 22: 1462-70.
  • Gimenez-Palop O, Gimenez-Perez G, Mauricio D, Berlanga E, Potau N, Vilardell C, et al. Circulating ghrelin in thyroid dysfunction is related to insulin resistance and not to hunger, food intake or anthropometric changes. Eur J Endocrinol 2005; 153: 73-79.
  • Erdogan M, Canataroglu A, Ganidagli S, Kulaksizoglu M. Metabolic syndrome prevalence in subclinic and overt hypothyroid patients and the relation among metabolic syndrome parameters. J Endocrinol Invest 2011; 34(7): 488-92.
  • Handisurya A, Pacini G, Tura A, Gessi A, Kautzky-Willer A. Effects of T4-replacement therapy on glucose metabolism in subjects with subclinical and overt hypothyroidism. Clin Endocrinol 2008; 69: 963-69.
  • Scarabottolo L, Trezzi E, Roma P, Gatapano AL. Experimental hypothyroidism modulates the expression of the low density lipoprotein receptor by the liver. Atherosclerosis 1986; 59: 329-33.
  • Diekman T, Demacker PN, Kastelein JJ, Stalenhoef AF, Wiersinga WM. Increased oxidizability of low-density lipoproteins in hypothyroidism. J Clin Endocrinol Metab 1998; 83: 1752-55.
  • O'Brien T, Katz K, Hodge D, Nguyen TT, Kottke BA, Hay ID. The effect of treatment of hypothyroidism and hyperthyroidism on plasma lipids and apolipoproteins AI, AII and E. Clin Endocrinol 1997; 46: 17-20.
  • Tanaci N, Ertugrul DT, Sahin M, Yucel M, Olcay I, Demirag NG, et al. Postprandial lipemia as a risk factor for cardiovascular disease in patients with hypothyroidism. Endocrine 2006; 29: 451-56.
  • Gjedde S, Gormsen LC, Rungby J, Nielsen S, Jorgensen JO, Pedersen SB et al. Decreased lipid intermediate levels and lipid oxidation rates despite normal lipolysis in patients with hypothyroidism. Thyroid 2010; 20: 843-49.
  • Martinez-Triguero ML, Hernandez-Mijares A, Nguyen TT, Munoz ML, Pena H, Morillas C, et al. Effect of thyroid hormone replacement on lipoprotein (a), lipids, and apolipoproteins in subjects with hypothyroidism. Mayo Clin Proc 1998; 73: 837-41.
  • Tzotzas T, Krassas GE, Konstantinidis T, Bougoulia M. Changes in lipoprotein(a) levels in overt and subclinical hypothyroidism before and during treatment. Thyroid 2000; 10(9): 803-8.
  • Spandrio S, Sleiman I, Scalvini T, Salvi A, Di Stefano O, Pagliaini R, et al. Lipoprotein (a) in thyroid dysfunction before and after treatment. Horm Metab Res 1993; 25(11): 586-9.
  • Pearce EN, Wilson PW, Yang Q, Vasan RS, Braverman LE. Thyroid function and lipid subparticle sizes in patients with short-term hypothyroidism and a population-based cohort. J Clin Endocrinol Metab 2008; 93: 888-94.
  • Goede DL, Wiesli P, Brandle M, Bestmann L, Bernays RL, Zwimpfer C, Schmid C, et al. Effects of thyroxine replacement on serum creatinine and cystatin C in patients with primary and central hypothyroidism. Swiss Med Wkly 2009; 139: 339-44.
  • Hanna FWF, Scanlon MF. Hyponatraemia, hypothyroidism and role of arginine-vasopressin. Lancet 1997; 350: 755-56.
  • Leeper RD, Benua RS, Brener JL, Rawson RW. Hyperuricemia in myxedema. J Clin Endocrinol Metab 1960; 20: 1457-66.
  • Jones JE, Desper PC, Shane SR, Flink EB. Magnesium metabolism in hyperthyroidism and hypothyroidism. J Clin Invest 1966; 45: 891-900.
  • Iglesias P, Diez JJ. Thyroid dysfunction and kidney disease. Eur J Endocrinol 2009; 160: 503-15.
  • Kilein I, Danzi S. Thyroid disease and the heart. Circulation 2007; 116: 1725-35.
  • Dernellis J, Panaretou M. Effects of thyroid replacement therapy on arterial blood pressure in patients with hypertension and hypothyroidism. Am Heart J 2002; 143: 718-24.
  • Hardisty CA, Naik DR, Munro DS. Pericardial effusion in hypothyroidism. Clin Endocrinol 1980; 13: 349-54.
  • Cappola AR, Ladenson PW. Hypothyroidism and atherosclerosis. J Clin Endocrinol Metab 2003; 88: 2438-44.
  • Diekman MJM, Put NM, Blom HJ, Tijssen JGP, Wiersinga WM. Determinants of changes in plasma homocysteine in hyperthyroidism and hypothyroidism. Clin Endocrinol 2001; 54: 197-204.
  • Ito M, Arishima T, Kudo T, Nishihara E, Ohye H, Kubota S, et al. Effect of levothyroxine replacement on non-high-density lipoprotein cholesterol in hypothyroid patients. J Clin Endocrinol Metab 2007; 92: 608-11.
  • Hak AE, Pols HA, Visser TJ, Drexhage HA, Hofman A, Witteman JC. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam study. Ann Int Med 2000; 132: 270-78.
  • Asik M, Sahin S, Ozkul F, Anaforoglu I, Ayhan S, Karagol S, Gunes F, Algun E. Evaluation of epicardial fat tissue thickness in patients with Hashimoto thyroiditis. Clin Endocrinol (Oxf). 2013 Oct;79(4):571-6. doi: 10.1111/cen.12176. Epub 2013 May 20.
There are 50 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Review Article
Authors

Ethem Cerit

Mujde Akturk This is me

Publication Date May 15, 2016
Published in Issue Year 2016

Cite

APA Cerit, E., & Akturk, M. (2016). Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis. Medical Science and Discovery, 3(5), 213-8. https://doi.org/10.17546/msd.31690
AMA Cerit E, Akturk M. Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis. Med Sci Discov. May 2016;3(5):213-8. doi:10.17546/msd.31690
Chicago Cerit, Ethem, and Mujde Akturk. “Atherosclerotic and Metabolic Effects of Hypothyroidism Due to Chronic Thyroiditis”. Medical Science and Discovery 3, no. 5 (May 2016): 213-8. https://doi.org/10.17546/msd.31690.
EndNote Cerit E, Akturk M (May 1, 2016) Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis. Medical Science and Discovery 3 5 213–8.
IEEE E. Cerit and M. Akturk, “Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis”, Med Sci Discov, vol. 3, no. 5, pp. 213–8, 2016, doi: 10.17546/msd.31690.
ISNAD Cerit, Ethem - Akturk, Mujde. “Atherosclerotic and Metabolic Effects of Hypothyroidism Due to Chronic Thyroiditis”. Medical Science and Discovery 3/5 (May 2016), 213-8. https://doi.org/10.17546/msd.31690.
JAMA Cerit E, Akturk M. Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis. Med Sci Discov. 2016;3:213–8.
MLA Cerit, Ethem and Mujde Akturk. “Atherosclerotic and Metabolic Effects of Hypothyroidism Due to Chronic Thyroiditis”. Medical Science and Discovery, vol. 3, no. 5, 2016, pp. 213-8, doi:10.17546/msd.31690.
Vancouver Cerit E, Akturk M. Atherosclerotic and metabolic effects of hypothyroidism due to chronic thyroiditis. Med Sci Discov. 2016;3(5):213-8.