Association of Subclinical Hypothyroidism and Cardiovascular Disease With Mortality

Inoue, Kosuke; Ritz, Beate; Brent, Gregory A.; Ebrahimi, Ramin; Rhee, Connie M.; Leung, Angela M.

doi:10.1001/jamanetworkopen.2019.20745

Cited by 140 publications

(98 citation statements)

References 40 publications

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“…Our analysis suggests a possible mechanism linking TSH to cardiovascular complications, which is a sensible alternative to the thyroid failure hypothesis by other authors (16). It also well accounts for the U-shaped relationship between TSH concentration and cardiovascular risk, as elsewhere described (14,15).…”

Section: Discussionsupporting

confidence: 83%

“…While increased and high-normal free thyroxine (FT4) concentration is a well-established risk factor for malignant arrhythmia and sudden cardiac death (6,7), the association between thyrotropin (TSH) concentration and cardiovascular mortality is less well understood (8)(9)(10)(11). Studies reported either no relation at all (12,13) or a rather complex Ushaped association (14,15), as has been shown in a recent population study based on the large NHANES datasets (16). Likewise, a recent study observed elevated FT4 concentration in stress cardiomyopathy or Takotsubo syndrome (17).…”

Section: Introductionmentioning

confidence: 99%

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The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

Dietrich

Hoermann²,

Midgley

et al. 2020

Front. Endocrinol.

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Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but on multiple confounders including genetic traits, medication and allostatic load. Especially psychosocial stress is a still underappreciated factor that is able to adjust the set point of thyroid function. In order to improve our understanding of thyroid allostasis, we undertook a systematic meta-analysis of published studies on thyroid function in post-traumatic stress disorder (PTSD). Studies were identified via MEDLINE/PubMed search and available references, and eligible were reports that included TSH or free thyroid hormone measurements in subjects with and without PTSD. Additionally, we re-analyzed data from the NHANES 2007/2008 cohort for a potential correlation of allostatic load and thyroid homeostasis. The available evidence from 13 included studies and 3386 euthyroid subjects supports a strong association of both PTSD and allostatic load to markers of thyroid function. Therefore, psychosocial stress may contribute to cardiovascular risk via an increased set point of thyroid homeostasis, so that TSH concentrations may be increased for reasons other than subclinical hypothyroidism. This provides a strong perspective for a previously understudied psychoendocrine axis, and future studies should address this connection by incorporating indices of allostatic load, peripheral thyroid hormones and calculated parameters of thyroid homeostasis.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

Dietrich

Hoermann²,

Midgley

et al. 2020

Front. Endocrinol.

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“…Another large pooled analysis of over 31,900 participants, also done by the Thyroid Studies Collaboration, found that the increased risk of coronary heart disease events in those with SCH did not vary by serum TPO antibody status (P for interaction = 0.65) (40). SCH has also been associated with all-cause mortality, mediated by CVD, in a study that used data from the National Health and Nutrition Examination Survey in the United States (41).…”

Section: Associations Between Sch and Cvdmentioning

confidence: 99%

Levothyroxine for the Treatment of Subclinical Hypothyroidism and Cardiovascular Disease

Sue

Leung

2020

Front. Endocrinol.

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Subclinical hypothyroidism is a biochemical condition defined by elevated serum thyroidstimulating hormone levels in the setting of normal levels of the peripheral thyroid hormones, thyroxine and triiodothyronine. Thyroid hormones act on the heart through various mechanisms and subclinical hypothyroidism has been associated with risk factors for cardiovascular disease, such as hypertension and dyslipidemia. In addition, evidence from multiple studies supports an association between subclinical hypothyroidism and cardiovascular disease. However, the use of levothyroxine in subclinical hypothyroidism to reduce cardiovascular disease risk is not clearly beneficial. Treatment with levothyroxine may only provide benefit in certain subgroups, such as patients who are younger or at higher risk of cardiovascular disease. At present, most of the international societal guidelines advise that treatment decisions should be individualized based on patient age, degree of serum thyroid-stimulating hormone (TSH) elevation, symptoms, cardiovascular disease (CVD) risk, and other co-morbidities. Further study in this area is recommended.

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“…En el estudio se encontró con mayor frecuencia el SM en pacientes con hipotiroidismo subclínico, así como mutualidad entre ambas. Se sabe que existe una asociación entre los niveles elevados de TSH y la enfermedad cardiovascular, así como que el SM conlleva mayor riesgo cardiovascular por daño endotelial 20,21 . En un estudio realizado por Razvi, se demostró que regular los niveles de TSH con levotiroxina en pacientes con hipotiroidismo subclínico estaba asociado a la disminución de eventos cardiovasculares 22 .…”

Section: Discussionunclassified

Síndrome metabólico en pacientes mexicanos con hipotiroidismo

Mendoza-Romo¹,

Ponce-Muñiz²,

Escudero-Lourdes³

et al. 2021

RME

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Objetivo: Determinar la prevalencia del síndrome metabólico en pacientes mexicanos con hipotiroidismo. Métodos: Se seleccionó una muestra de 293 pacientes con diagnóstico de hipotiroidismo durante un lapso de seis meses. Se analizó el perfil de lípidos, el perfil tiroideo, la glucosa en ayuno, la presión arterial, el peso, la talla y el perímetro abdominal. Se tomaron los criterios de la Federación Internacional de Diabetes para el diagnóstico de síndrome metabólico. Resultados: Del total de pacientes estudiados, un 12% (35) fueron hombres y un 88% (258) mujeres, se encontró el 65% (190) con síndrome metabólico, el cual fue mayor en aquellos con hipotiroidismo subclínico, 76% (60), que en hipotiroidismo clínico, 60% (130). Los componentes más frecuentemente encontrados en los pacientes estudiados fueron niveles bajos de colesterol ligado a lipoproteínas de alta densidad en el 82% (240) y obesidad central en el 77% (226). Conclusiones: Existe una mayor presencia de síndrome metabólico en pacientes con hipotiroidismo, sobre todo en aquellos con hipotiroidismo subclínico, por lo que se sugiere una búsqueda de ambas enfermedades para un adecuado manejo y control del riesgo cardiovascular.

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Association of Subclinical Hypothyroidism and Cardiovascular Disease With Mortality

Cited by 140 publications

References 40 publications

The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

Levothyroxine for the Treatment of Subclinical Hypothyroidism and Cardiovascular Disease

Síndrome metabólico en pacientes mexicanos con hipotiroidismo

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