The Thyroid Epidemiology, Audit, and Research Study (TEARS): Morbidity in Patients with Endogenous Subclinical Hyperthyroidism

Vadiveloo, Thenmalar; Donnan, Peter T.; Cochrane, Lindy; Leese, Graham

doi:10.1210/jc.2010-2693

Cited by 160 publications

(138 citation statements)

References 21 publications

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“…Endogenous subclinical thyrotoxicosis has been associated with atrial fibrillation in multiple studies, with the risk proportional to the degree of TSH suppression (19)(20)(21)(22)(23)(24). This increased risk of atrial fibrillation appears to be similar when thyrotoxicosis stems from overtreatment with thyroid hormone supplementation (22).…”

Section: Introductionmentioning

confidence: 99%

Thyroid Hormone Therapy and Risk of Thyrotoxicosis in Community-Resident Older Adults: Findings from the Baltimore Longitudinal Study of Aging

Mammen

McGready

Oxman

et al. 2015

Thyroid

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Background: Both endogenous and exogenous thyrotoxicosis has been associated with atrial fibrillation and low bone mineral density. Therefore, this study investigated the risk factors associated with prevalent and incident thyrotoxicosis and the initiation of thyroid hormone therapy in a healthy, aging cohort. Methods: A total of 1450 ambulatory community volunteer participants in the Baltimore Longitudinal Study of Aging examined at the NIA Clinical Research Unit in Baltimore, MD, have undergone longitudinal monitoring of serum thyrotropin (TSH) and thyroid hormone (free thyroxine and free triiodothryonine) levels as well as medication use every one to four years, depending on age, between 2003 and 2014. Results: The prevalence of low TSH was 9.6% for participants on thyroid hormone and 0.8% for nontreated individuals ( p < 0.001). New cases occurred at a rate of 17.7/1000 person-years of exposure to thyroid hormone therapy [CI 9-32/1000] and 1.5/1000 person-years in the unexposed population [CI 0.7-2.9/1000]. Women were more likely to be treated and more often overtreated than men were. The adjusted hazard ratio (HR) for thyrotoxicosis between treated and untreated women was 27.5 ([CI 7.2-105.4]; p < 0.001) and 3.8 for men ([CI 1.2-6.3]; p < 0.01). White race/ethnicity and older age were risk factors for thyroid hormone therapy but not overtreatment. Body mass index was not associated with starting therapy (HR = 1.0). Thyroid hormone initiation was highest among women older than 80 years of age (3/100 person-years). For one-third of treated participants with follow-up data, overtreatment persisted at least two years. Conclusions: Iatrogenic thyrotoxicosis accounts for approximately half of both prevalent and incident low TSH events in this community-based cohort, with the highest rates among older women, who are vulnerable to atrial fibrillation and osteoporosis. Physicians should be particularly cautious in treating subclinical hypothyroidism in elderly women in light of recent studies demonstrating no increased risk of cardiovascular morbidity or death for individuals with elevated TSH levels <10 mIU/L.

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Section: Introductionmentioning

confidence: 99%

Thyroid Hormone Therapy and Risk of Thyrotoxicosis in Community-Resident Older Adults: Findings from the Baltimore Longitudinal Study of Aging

Mammen

McGready

Oxman

et al. 2015

Thyroid

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“…Both overt hypothyroidism and hyperthyroidism have been associated with increased risk of fractures in previous studies (6,7,8,9,10,11,12,13,14). Other studies have reported that fractures are more common in persons with subclinical thyroid dysfunction (15,16), and some have found fracture incidence to increase by decreasing thyroid-stimulating hormone (TSH) within the reference range (13,17,18). However, the results of these and other studies are inconsistent (7,13,14,19,20).…”

Section: Introductionmentioning

confidence: 99%

Does thyroid function influence fracture risk? Prospective data from the HUNT2 study, Norway

Svare

Nilsen

Åsvold

et al. 2013

European Journal of Endocrinology

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Objective: To prospectively study the relation between TSH and risk of hip and forearm fractures. Design: A population-based cohort study. Methods: In a substudy of the second survey of the Nord Trøndelag Health Study, Norway (HUNT2, 1995-97), linked with a hospital-based fracture registry, we investigated the relation between baseline TSH and risk of hip and/or forearm fractures. Population: A total of 16 610 women and 8595 men aged 40 years or more, without previous self-reported thyroid disease and hip or forearm fractures. Results: During 12.5 years follow-up, a total of 1870 women and 342 men experienced hip or forearm fractures. Overall, there was no relation between baseline TSH and fracture risk. However, there was weak evidence that women with TSH !0.5 and O3.5 mU/l had a slightly increased risk of hip fractures (hazard ratio (HR) 1.30, 95% CI 0.97-1.94 and HR 1.19, 95% CI 0.93-1.52) compared with the reference group with TSH of 1.5-2.4 mU/l. Supplementary analyses showed higher hip fracture risk in women with TSH O4.0 mU/l and negative thyroid peroxidase antibodies (TPOAb) compared with the reference group (HR 1.75, 95% CI 1.24-2.46). Conclusion: We found no statistically significant relation between baseline TSH and subsequent fracture risk, but the data suggest a weak positive association with hip fracture risk among women with both low and high TSH. The latter association was confined to women with negative TPOAb status.

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“…SCH has been found to be associated with a higher risk of atrial fibrillation, hypertension, osteoporosis, and dementia compared with euthyroid subjects in some (3,4,5,6) but not all (7,8,9) studies. Similarly, the findings from the cohort studies on the association between SCH and cardiovascular disease (CVD), cardiovascular, and all-cause mortality were also inconsistent (10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27). Lack of randomized clinical trials answering the question whether long-term health outcomes are improved by treatment of SCH made this issue more elusive.…”

Section: Introductionmentioning

confidence: 99%

“…Since the latest meta-analysis had been performed (31), the interest of researchers on this issue rose. A total of 11 new large prospective studies (17,18,19,20,21,22,23,24,25,26,27) on this issue have been published. Now data are sufficient to update the meta-analysis to provide more powerful evidence for physicians and policy-makers.…”

Section: Introductionmentioning

confidence: 99%

Subclinical hyperthyroidism and the risk of cardiovascular events and all-cause mortality: an updated meta-analysis of cohort studies

Yang

Jiang²,

Qi³

et al. 2012

European Journal of Endocrinology

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Objectives: Whether subclinical hyperthyroidism (SCH) results in poor prognosis remains controversial. Our aim was to evaluate the association between SCH and the risk of cardiovascular disease (CVD), cardiovascular mortality, and all-cause mortality by conducting a meta-analysis of cohort studies. Methods: The PubMed and Embase databases were searched through November 2011 to identify studies that met pre-stated inclusion criteria. Relevant information for analysis was extracted. Either a fixed or a random effects model was used to calculate the overall combined risk estimates. Results: Seventeen cohort studies were included in this meta-analysis. The overall combined relative risks for individuals with SCH compared with the reference group were 1.19 (95% confidence interval (CI): 1.10 to 1.28) for CVD, 1.52 (95% CI: 1.08 to 2.13) for cardiovascular mortality, and 1.25 (95% CI: 1.00 to 1.55) for all-cause mortality. Subgroup analysis by sample source (community or convenience sample) showed that the significant association for cardiovascular and all-cause mortality only existed when pooling studies from convenience samples. Heterogeneity was observed when pooling studies on the association between SCH and cardiovascular and all-cause mortality. Sensitivity analysis showed omission of each individual study did not significantly change the pooled effects. No evidence of publication bias was observed. Conclusions: Our findings demonstrated that SCH significantly increased the risk of CVD for the general population and the risk of cardiovascular and all-cause mortality for the individuals with other morbidities.

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The Thyroid Epidemiology, Audit, and Research Study (TEARS): Morbidity in Patients with Endogenous Subclinical Hyperthyroidism

Abstract: Patients with endogenous SH have an increased risk of cardiovascular disease and dysrhythmia. There is an association with fracture and dementia that is not related to TSH concentration and therefore is less likely to be causally related. No association was found between SH and cancer.

Cited by 160 publications

References 21 publications

Thyroid Hormone Therapy and Risk of Thyrotoxicosis in Community-Resident Older Adults: Findings from the Baltimore Longitudinal Study of Aging

Thyroid Hormone Therapy and Risk of Thyrotoxicosis in Community-Resident Older Adults: Findings from the Baltimore Longitudinal Study of Aging

Does thyroid function influence fracture risk? Prospective data from the HUNT2 study, Norway

Subclinical hyperthyroidism and the risk of cardiovascular events and all-cause mortality: an updated meta-analysis of cohort studies

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