Thyrotropin and Free Thyroxine Concentrations Do Not Affect Cardiovascular Disease and Mortality in Euthyroid Peritoneal Dialysis Patients

Pérez, Susana Moraleda; Díez, Juan J.; Bajo, María Auxiliadora; Iglesias, Pedro; Grande, Cristina; Peso, Gloria del; Madero, Rosário; Ossorio, Marta; Selgas, Rafael

doi:10.3747/pdi.2012.00098

Cited by 4 publications

(5 citation statements)

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“…In euthyroid subjects, TSH is an independent predictor of cardiovascular disease [ 22 ]. FT4 is associated with differing metabolic markers [ 10 ]. Recently, a study in the general population has found that serum FT4 levels predict the risk of T2D and CVD [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…International Journal of Endocrinology with differing metabolic markers [10]. Recently, a study in the general population has found that serum FT4 levels predict the risk of T2D and CVD [23].…”

Section: Discussionmentioning

confidence: 99%

“…However, the influence of thyroid hormones on CVD was inconclusive. Pérez et al [ 10 ] found that thyrotropin (TSH) and free thyroxine (FT4) concentrations do not affect cardiovascular disease and mortality in euthyroid peritoneal dialysis patients. Others found that subclinical hypothyroidism is a risk factor for CVD in T2D patients [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical Associations of Thyroid Hormone Levels with the Risk of Atherosclerosis in Euthyroid Type 2 Diabetic Patients in Central China

Wang

Chen

Yu³

et al. 2020

International Journal of Endocrinology

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Background. Thyroid function is associated with the etiology and pathogenesis of type 2 diabetes (T2D) and potentially contributes to the development of the complications of T2D. The association of thyroid hormones with atherosclerosis in euthyroid T2D patients is not clear. Purpose. To investigate the association of thyroid hormone levels with the risk of developing atherosclerosis in euthyroid T2D patients in Central China. Methods. This cross-sectional study recruited 910 euthyroid T2D patients from Henan Provincial People’s Hospital, China. Association among hemoglobin A1c (HbA1c), thyroid hormones, and the prevalence of atherosclerosis was assessed by multivariable Cox models after adjusting for covariates including age, BMI, duration of T2D, smoking status, SBP, TC, family history of T2D, and medications on hyperlipidemia. Results. Among all 910 subjects, 373 were diagnosed with atherosclerosis. There were 523 females and 387 males included in this study. The mean age was 51.9 years. The average BMI was 25.3 kg/m2. Low-normal serum-free triiodothyronine (FT3) levels (3.50–4.17 pmol/L) were associated with a high prevalence of atherosclerosis. Comparing with low-normal FT3, the prevalence ratio in patients with mid- (4.17–4.83 pmol/L) and high-normal FT3 level (4.83–6.50 pmol/L) is 0.74 (95% CI 0.56 to 0.97, p=0.029) and 0.63 (95% CI 0.46 to 0.87, p=0.005) after adjusting for covariates. High level of free thyroxine (FT4) also had decreased risk for atherosclerosis. Thyroid-stimulating hormone (TSH) and FT3 to FT4 ratio did not show significant association with the development of atherosclerosis. Conclusion. T2D patients with low but clinically normal FT3 level are more likely to develop macrovascular complications comparing with those with mid- and high-normal FT3 level.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical Associations of Thyroid Hormone Levels with the Risk of Atherosclerosis in Euthyroid Type 2 Diabetic Patients in Central China

Wang

Chen

Yu³

et al. 2020

International Journal of Endocrinology

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“…Another single-center study that enrolled 278 PD patients also did not find a significant relationship between time-dependent fT4 levels and cardiovascular mortality. The retrospective study design and enrollment period of>30 years may have reduced the statistical power in that study [23] .…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies mostly focused on the effect of abnormal thyroid function on cardiovascular outcomes [6] , [18] , [22] , [23] . Cardiovascular disease was reported to be a leading cause of death in the ESRD patients from other cohorts [29] , [30] .…”

Section: Discussionmentioning

confidence: 99%

Free Thyroxine Level as an Independent Predictor of Infection-Related Mortality in Patients on Peritoneal Dialysis: A Prospective Multicenter Cohort Study

et al. 2014

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BackgroundPrevious studies have reported the relationship between thyroid hormone levels and mortality in dialysis patients. However, little is known about the association of free thyroxine (fT4) and mortality in patients on peritoneal dialysis (PD). This study investigated the association between basal and annual variation in fT4 level and mortality in PD patients.MethodsPatients on maintenance PD were enrolled from a prospective multicenter cohort study in Korea; their serum triiodothyronine, fT4, and thyroid-stimulating hormone levels were measured 12 months apart. Patients with overt thyroid disease and those receiving thyroid hormone replacement therapy were excluded from the analysis. Patients were divided into two groups based on the median levels of fT4. The differences of all-cause, infection-related, and cardiovascular mortalities were analyzed between the two groups. The association of basal levels and annual variation with mortality was investigated with Kaplan–Meier curves and Cox proportional hazard models.ResultsAmong 235 PD patients, 31 (13.2%) deaths occurred during the mean follow-up period of 24 months. Infection (38.7%) was the most common cause of death. Lower basal fT4 levels were an independent predictor of all-cause and infection-related death (hazard ratio [HR] = 2.74, 95% confidence interval [CI] 1.27–5.90, P = 0.01, and HR = 6.33, 95% CI 1.16–34.64, P = 0.03, respectively). Longitudinally, patients with persistently lower fT4 levels during the 12-month period had significantly higher all-cause mortality than those with persistently higher levels (HR = 3.30, 95% CI 1.15–9.41, P = 0.03). The area under the receiver operating characteristic curve of fT4 for predicting all-cause and infection-related mortality was 0.60 and 0.68, respectively.ConclusionsfT4 level is an independent predictor of mortality and is especially attributable to infection in PD patients. This predictor was consistent when considering both baseline measurements and annual variation patterns. Close attention to infection in PD patients with relatively lower fT4 levels should be considered.

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Thyroid dysfunction and kidney disease: An update

Iglesias

Bajo

Selgas

et al. 2016

Rev Endocr Metab Disord

187

130

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Thyroid hormones influence renal development, kidney hemodynamics, glomerular filtration rate and sodium and water homeostasis. Hypothyroidism and hyperthyroidism affect renal function by direct renal effects as well as systemic hemodynamic, metabolic and cardiovascular effects. Hypothyroidism has been associated with increased serum creatinine and decreased glomerular filtration rate. The reverse effects have been reported in thyrotoxicosis. Most of renal manifestations of thyroid dysfunction are reversible with treatment. Kidney disease may also cause thyroid dysfunction by several mechanisms. Nephrotic syndrome has been associated to changes in serum thyroid hormone concentrations. Different forms of glomerulonephritis and tubulointerstitial disease may be linked to thyroid derangements. A high prevalence of thyroid hormone alteration has been reported in acute kidney injury. Thyroid dysfunction is highly prevalent in chronic kidney disease patients. Subclinical hypothyroidism and low triiodothyronine syndrome are common features in patients with chronic kidney disease. Patients treated by both hemodialysis and peritoneal dialysis, and renal transplantation recipients, exhibit thyroid hormone alterations and thyroid disease with higher frequency than that found in the general population. Drugs used in the therapy of thyroid disease may lead to renal complications and, similarly, drugs used in kidney disorders may be associated to thyroid alterations. Lastly, low thyroid hormones, especially low triiodothyronine levels, in patients with chronic kidney disease have been related to a higher risk of cardiovascular disease and all-cause mortality. Interpretation of the interactions between thyroid and renal function is a challenge for clinicians involved in the treatment of patients with thyroid and kidney disease.

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Thyrotropin and Free Thyroxine Concentrations Do Not Affect Cardiovascular Disease and Mortality in Euthyroid Peritoneal Dialysis Patients

Cited by 4 publications

References 6 publications

Clinical Associations of Thyroid Hormone Levels with the Risk of Atherosclerosis in Euthyroid Type 2 Diabetic Patients in Central China

Clinical Associations of Thyroid Hormone Levels with the Risk of Atherosclerosis in Euthyroid Type 2 Diabetic Patients in Central China

Free Thyroxine Level as an Independent Predictor of Infection-Related Mortality in Patients on Peritoneal Dialysis: A Prospective Multicenter Cohort Study

Thyroid dysfunction and kidney disease: An update

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