Homocysteine and its relation to B-vitamins in Graves’ disease before and after treatment: effect modification by smoking

Authors


Dr Bjørn G. Nedrebø, Department of Biochemical Endocrinology, Haukeland University Hospital, N-5021 Bergen, Norway (fax: +47 55975814; e-mail: bjorn.nedrebo@ikb.uib.no).

Abstract

Abstract. Nedrebø BG, Hustad S, Schneede J, Ueland PM, Vollset SE, Holm PI, Aanderud S, Lien EA (University of Bergen; Haukeland University Hospital, Bergen; and Haugesund Hospital, Haugesund; Norway). Homocysteine and its relation to B-vitamins in Graves’ disease before and after treatment: effect modification by smoking. J Intern Med 2003; 254: 504–512.

Objectives. To investigate plasma total homocysteine levels and its relation to B-vitamins and smoking in Graves’ disease before and after antithyroid therapy.

Design. A longitudinal study taking place at four hospitals in Norway.

Methods and subjects. Plasma total homocysteine, serum folate, serum cobalamin and riboflavin, flavin mononucleotide and flavin adenine dinucleotide in plasma were investigated in 182 patients with hyperthyroidism before treatment. The same parameters were reinvestigated in 112 of these patients after attaining euthyroid state.

Results. In hyperthyroidism, plasma total homocysteine was low, and inversely related to folate, cobalamin and riboflavin, and positively related to serum creatinine and age. Following antithyroid therapy, total homocysteine increased and the concentration of folate, cobalamin, riboflavin, flavin mononucleotide and flavin adenine dinucleotide decreased significantly. The most pronounced reduction (35%) was observed for flavin mononucleotide. In the hyperthyroid state, smokers had lower levels of folate and flavin mononucleotide than non-smokers. After restoration of euthyroidism, both folate and riboflavin were significantly lower in smokers than non-smokers. Plasma total homocysteine increased according to decreasing quartiles of B-vitamins. For riboflavin, this relation was confined to smokers.

Conclusion. Plasma total homocysteine changes according to thyroid status. These changes may be partly attributable to altered folate, cobalamin but also riboflavin status, particulary in smokers.

Ancillary