Food Security and Income Are Predictors of Low Thyroid Stimulating Hormone (TSH) Levels in Latinx Adults With Euthyroidism – A Community-Based Study

Abstract

ObjectivesHealth disparities are present in thyroid disorders because of multiple systemic and patient factors. Thyroid dysfunction may be a risk factor for cardiovascular disease, within the euthyroid range and other outcomes such as mood disorders may be impacted. The aim of this study was to examine the relationship between thyroid function (TSH) and social determinants of health and clinical measures in an euthyroid Latinx patient sample from a community health clinic. MethodsA needs assessments was completed using a random sample of 93 de-identified medical records of individuals seeking mental health care at Caridad Center in Boynton Beach, Fl. Demographics, diagnoses, laboratory tests results and the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) questionnaire data were abstracted. The cut-off point for high TSH was ≥2 mU/L and low TSH as <2 mU/L. Statistical analyses included descriptive statistics, Mann-Whitney U, chi-squared tests, and logistic regression. ResultsThe mean age was 51.9 ± 11.8 years and 82.8% were female. Over 75% were within 100% of the federal poverty level (FPL) and over 30% were food insecure. Those with low TSH compared with high TSH, had a higher proportion of food insecurity (43.5% vs 18.8%, P = 0.009) and 100% FPL level (86.4% vs. 63.4%, p = 0.013). In the univariate models, food insecurity (OR 3.33, 95% CI 1.31–8.44, P = 0.011) and 100% FPL (OR 4.68, 95% CI 1.51–14.48, P = 0.007) was positively associated with the risk of having low TSH. These relationships remained in the multivariate models for food security (OR 3.69, 95% CI 1.27–10.75, P = 0.016) and 100% FPL (OR 4.03, 95% CI 1.30–12.45, P = 0.015), adjusted for age, sex, BMI, hypertension, diabetes, cardiovascular disease risk factors, multimorbidity, and unemployment. ConclusionsIn a euthyroid Latinx adult population who received mental health care at a community clinic, lower TSH levels was independently associated with measures of poverty. There is controversy in the literature about the normal range of TSH, especially since subclinical hypothyroidism within the normal range may still be associated with adverse health outcomes. These relationships warrant further study in order to inform future public health policies and follow-up care for underserved and vulnerable communities. Funding SourcesFIU RCMI/NIMHD.