Effects of Subclinical Thyroid Dysfunction on the Heart

Biondi, Bernadette; Palmieri, Emiliano Antonio; Lombardi, Gaetano; Fazio, Serafino

doi:10.7326/0003-4819-137-11-200212030-00011

Cited by 386 publications

(275 citation statements)

References 99 publications

Supporting

Mentioning

242

Contrasting

Unclassified

Order By: Relevance

“…Both subclinical and overt hypothyroidism have been associated with normal/ depressed systolic function, left ventricular diastolic dysfunction at rest, systolic and diastolic dysfunction during effort, increased peripheral vascular resistance, and impaired endothelial function (18,19). The similar pattern of these cardiovascular abnormalities in subclinical and overt hypothyroidism suggests that there is a continuum in cardiovascular effects related to thyroid hormone deficiency and also that a lesser degree of thyroid hormone deficiency may induce severe cardiovascular abnormalities.…”

Section: Cardiovascular Effects Of Short-term Hypothyroidismmentioning

confidence: 76%

Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences

Duntas¹,

Biondi²

2007

eur j endocrinol

Self Cite

View full text Add to dashboard Cite

Acute hypothyroidism induced by thyroid hormone withdrawal in patients with differentiated thyroid cancer during monitoring for remnant or metastatic disease, seriously affects multiple organs and systems, and especially in severe cases can impair quality of life. Indeed, it may induce untoward cardiovascular effects and can be hazardous in patients with underlying cardiovascular disease, particularly in the elderly. Moreover, acute hypothyroidism deranges the lipid profile and exacerbates neuropsychiatric illness. The introduction of recombinant human TSH (rhTSH) as a diagnostic and therapeutic tool in the care of patients with thyroid cancer has widened the scope of disease management. The use of rhTSH prevents derangement of various systems at approximately equivalent societal costs to that of withdrawal and promotes compliance while preserving the patient's normal daily functioning and productivity. Its reliability allied with its safety render this compound a valid alternative in the monitoring of patients with differentiated thyroid carcinoma as well as providing an alternative therapeutic procedure whenever LT4-withdrawal may be hazardous or in cases of patient non-compliance.

show abstract

Section: Cardiovascular Effects Of Short-term Hypothyroidismmentioning

confidence: 76%

Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences

Duntas¹,

Biondi²

2007

eur j endocrinol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Persistent subclinical hyperthyroidism by TSH-suppressive doses of levothyroxine has been shown to affect heart morphology and function in different groups of patients. Biondi et al showed that subclinical hyperthyroidism is associated with increased heart rate, atrial arrhythmias, increased left ventricular mass with marginal concentric remodeling, impaired ventricular relaxation, reduced exercise performance and increased risk for cardiovascular death [17]. Another study by Donatelli et al, on women with overt and subclinical hyperthyroidism, indicated a global impairment of diastolic heart performance, complicated in overt hyperthyroidism by left ventricular concentric hypertrophy [18].…”

Section: Discussionmentioning

confidence: 99%

The Evaluation of Left Ventricular Hypertrophy in Hypertensive Patients with Subclinical Hyperthyroidism

Tamer

Sargın

et al. 2005

Endocr J

View full text Add to dashboard Cite

Abstract. The aim of this prospective cross-sectional study was to investigate the hypertrophic effects of endogenous subclinical hyperthyroidism on myocardium and early development of left ventricular hypertrophy (LVH) in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. A total of 31 consecutive patients with stage I hypertension were included in the study. Sixteen of them also had endogenous subclinical hyperthyroidism that they were unaware before. The patients and the controls formed out of ten healthy subjects all underwent an investigation of thyroid functions and cardiologic evaluation. The mean wall thickness of the left ventricle in the stage I hypertensive group with endogenous subclinical hyperthyroidism (group I) was significantly increased as compared with both hypertensive patients without thyroid disease (group II) and the control subjects. The mean left ventricle mass was also significantly higher in group I than group II. Both of the patients' groups had an increased prevalence of LVH as compared with the controls. In this study, hypertensive patients with subclinical hyperthyroidism presented more increase in left ventricular mass, suggesting that subclinical hyperthyroidism may contribute to left ventricular hypertrophy forming a natural progression to hypertension. The hypertensive population should always be screened for endogenous subclinical hyperthyroidism, and should be examined for the criteria of left ventricular hypertrophy by echocardiography in early stages. SUBCLINICAL hyperthyroidism is characterized by persistently suppressed plasma thyroid stimulating hormone (TSH) concentrations and the presence of normal levels of free thyroxine (fT 4 ) and free triiodothyronine (fT 3 ) hormones. Subclinical hyperthyroidism can be the result of the same causes of overt clinical hyperthyroidism but patients with subclinical hyperthyroidism do not usually show specific symptoms and signs of hyperthyroidism [1,2]. It has been demonstrated that exogenous subclinical hyperthyroidism, in which patients treated with TSHsuppressive doses of levothyroxine, may affect the heart as in subjects with overt hyperthyroidism, but it remains controversial whether endogenous subclinical hyperthyroidism affects the heart [3][4][5].Situations in which thyroid hormones were increased have been shown to stimulate myocardial hypertrophy. Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality. Hypertension may also cause left ventricular myocardial hypertrophy. The importance of LVH in the prognosis of hypertension is well known because it clearly shows the duration and the severity of high blood pressure [6][7][8].Since hypertension and hyperthyroidism both may result in myocardial hypertrophy, we designed a crosssectional study to investigate the early development of LVH in essential hypertensive patients accompanied by endogenous subclinical hyperthyroidism. It could

show abstract

“…In fact, 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of wellbeing, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overdrive. 'Subclinical' hyperthyroidism exerts many relevant effects on the cardiovascular system (113). It is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by impaired diastolic function and, sometimes, by reduced systolic performance on effort and decreased exercise tolerance.…”

Section: Discussionmentioning

confidence: 99%

Subclinical hyperthyroidism: clinical features and treatment options

et al. 2005

Self Cite

View full text Add to dashboard Cite

Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.European Journal of Endocrinology 152 1-9

show abstract

Effects of Subclinical Thyroid Dysfunction on the Heart

Cited by 386 publications

References 99 publications

Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences

Short-term hypothyroidism after Levothyroxine-withdrawal in patients with differentiated thyroid cancer: clinical and quality of life consequences

The Evaluation of Left Ventricular Hypertrophy in Hypertensive Patients with Subclinical Hyperthyroidism

Subclinical hyperthyroidism: clinical features and treatment options

Contact Info

Product

Resources

About