Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

He, Wei; Li, Sheli; Zhang, Jinan; Zhang, Jing; Mu, Kaida; Li, Xinming

doi:10.3389/fendo.2018.00454

Cited by 27 publications

(9 citation statements)

References 90 publications

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“…The relation between subclinical hypothyroidism and hypertension has always been a controversial issue [ 9 ]. The previous meta-analyses have also reported inconsistent results on this matter [ 24 ]. Previous research disputes have focused on the level of office blood pressure [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure

Cai

Peng

Chen

et al. 2020

Journal of Hypertension

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Objective: To investigate the characteristics of blood pressure in subclinical hypothyroidism by combining office blood pressure and 24-h ambulatory blood pressure. Methods: A total of 3078 adults voluntarily participants were enrolled in this study between December 2017 and November 2019. Among 1431 of them who did not fit exclusion criteria, 104 patients were with subclinical hypothyroidism (S-HYPO group), and 1327 were euthyroid participants (euthyroid group). Office blood pressure measurement and 24-h ambulatory blood pressure monitoring were carried out to analyze the characteristics of blood pressure in subclinical hypothyroidism. Results: There was no statistical difference in office SBP and DBP between the S-HYPO group and the euthyroid group ( P > 0.05). On the ambulatory blood pressure level, the daytime SBP, night-time SBP, night-time SBP, 24-h SBP and DBP in the S-HYPO group were significantly higher than those in the euthyroid group ( P = 0.048, P = 0.002, P = 0.003, P = 0. 014, P = 0. 046, respectively), and the proportion of nondipper blood pressure in the S-HYPO group was higher than that in the euthyroid group. Comprehensive analysis of blood pressure inside and outside the joint clinic revealed that the S-HYPO group was independently related to sustained hypertension and masked hypertension but not to white-coat hypertension ( P = 0.004, P = 0.002, P = 0.886, respectively). After adjusting for age, sex, BMI, and other confounding factors, the above differences were still statistically significant ( P < 0.05). Conclusion: The characteristics of blood pressure in subclinical hypothyroidism can be more accurately understood by combining office blood pressure and ambulatory blood pressure.

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Section: Discussionmentioning

confidence: 99%

Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure

Cai

Peng

Chen

et al. 2020

Journal of Hypertension

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“…So it suggested that post-pregnancy treatment may reduce the chance for LT4 to have a beneficial effect. And the latest meta-analysis shows that LT4 replacement therapy can reduce blood pressure in SCH patients (29). But to date, the universal screening for thyroid function in childbearing women has been much debated in the scientific literature (6).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy

Liu

Wang

et al. 2019

Front. Endocrinol.

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Subclinical hypothyroidism (SCH) is a mild form of hypothyroidism that is common among women of childbearing age. The impact of SCH on adverse perinatal outcomes is unclear and universal screening for thyroid function before or during pregnancy is also much debated. In the present retrospective cohort study on 7,587 women from Shanghai, we assessed whether SCH was associated with adverse perinatal outcomes. The relationship between the risks of adverse outcomes and the time of screening and LT4 treatment status for SCH were also evaluated. SCH was associated with hypertensive disorders of pregnancy (HDP) [odds ratio (OR): 4.04; 95% confidence interval (CI): 1.85–8.84; P = 0.000]. After classification into four different groups based on the time of screening for thyroid function, the increased likelihood of HDP persisted in those diagnosed with SCH in the first and second trimesters (OR: 9.69; 95% CI: 1.73–54.48; P = 0.01 and OR: 3.66; 95% CI: 1.07–12.57, P = 0.03, respectively). The diagnosis of SCH in the preconception period and the third trimester was not significantly associated with HDP and other adverse perinatal outcomes. Five out of 120 (5/120) treated women (4.17%) vs. 4/45 untreated women (8.89%) developed HDP, 4/5 were treated after conception. The results indicate that during pregnancy, SCH conferred an increased risk of HDP, particularly in women diagnosed with the disorder in the first and second trimesters.

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“…Only longitudinal studies can confirm this hypothesis and establish whether a substitutive treatment with levothyroxine is really needed in these patients [31]. A recent systematic review suggests that levothyroxine replacement therapy can reduce blood pressure in adults with SCH but the results need to be validated in more clinical trials with larger samples [32]. Similar trials are also needed in obese children with IsHT.…”

Section: Discussionmentioning

confidence: 99%

Levothyroxine supplementation for obesity-associated thyroid dysfunction in children: a prospective, randomized, case control study

Kumar

Dayal

Attri

et al. 2019

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Introduction: The specific treatment of thyroid dysfunction associated with simple obesity (SO) in children is controversial. Material and methods: Fifty-one children having SO (BMI ≥ 2 Z-score) aged 6-12 years with elevation of serum thyroid stimulating hormone (TSH) (4-10 mIU/l) with or without alterations in serum triiodothyronine (T3) or thyroxine (T4) were randomised to receive either routine weight management intervention (group 1, n = 25) or additional low dose levothyroxine (~0.5 μg/kg/day) (group 2, n = 26) and followed up at 3-month intervals for 6 months. Results: The mean BMI Z-scores decreased in both groups from baseline to 3 and 6-month time points (group 1, 3.69 ±1.31 to 3.24 ±1.45 to 2.84 ±1.46, p = 0.03 and group 2, 4.31 ±2.11 to 4.08 ±1.92 to 3.50 ±1.93, p = 0.02). However, the decrease was similar in the 2 groups (-0.80 ±0.77 vs-0.97 ±0.69, p = 0.19). All children had isolated hyperthyrotropinemia. The mean TSH levels decreased from baseline to endpoint in group 1 (5.51 ±1.0 to 4.14 ±1.0 to 4.04 ±1.1 mIU/l, mean change-1.44 ±1.20, p = 0.001) and in group 2 (5.89 ±1.10 to 5.89 ±1.10 to 3.89 ±1.48 mIU/l, mean change-1.93 ±1.15, p = 0.001). The decrease in TSH levels was also similar in the 2 groups (p = 0.69). TSH normalized in 48% and 57.6% in group 1 and group 2 respectively. The decrease in total cholesterol and triglycerides was also similar in the 2 groups. Conclusions: Addition of levothyroxine to weight management interventions has no beneficial effect on BMI reduction as well as parameters of lipid and thyroid profiles, and should not be prescribed to children with obesity associated thyroid dysfunction.

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Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Cited by 27 publications

References 90 publications

Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure

Blood pressure characteristics of subclinical hypothyroidism: an observation study combined with office blood pressure and 24-h ambulatory blood pressure

The Impact of Subclinical Hypothyroidism on Adverse Perinatal Outcomes and the Role of Thyroid Screening in Pregnancy

Levothyroxine supplementation for obesity-associated thyroid dysfunction in children: a prospective, randomized, case control study

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