Levothyroxine Treatment of Subclinical Hypothyroidism, Fatal and Nonfatal Cardiovascular Events, and Mortality

Abstract

BACKGROUND Subclinical hypothyroidism (SCH) has been associated with ischemic heart disease (IHD); however, it is unknown whether treatment of SCH with levothyroxine sodium will reduce the risk of IHD. The aim of this study was to investigate the association between levothyroxine treatment of SCH with IHD morbidity and mortality. METHODS We used the United Kingdom General Practitioner Research Database to identify individuals with new SCH (serum thyrotropin levels of 5.01-10.0 mIU/L and normal free thyroxine levels) recorded during 2001 with outcomes analyzed until March 2009. All analyses were performed separately for younger (40-70 years) and older (>70 years) individuals. Hazard ratios (HRs) for IHD events (fatal and nonfatal) were calculated after adjustment for conventional IHD risk factors, baseline serum thyrotropin levels, and initiation of levothyroxine treatment as a time-dependent covariate. RESULTS Subclinical hypothyroidism was identified in 3093 younger and 1642 older individuals. For a median follow-up period of 7.6 years, 52.8% and 49.9% of younger and older patients with SCH were treated with levothyroxine, respectively. There were 68 incident IHD events in 1634 younger patients treated with levothyroxine (4.2%) vs 97 IHD events in 1459 untreated individuals (6.6%) (multivariate-adjusted HR, 0.61; 95% CI, 0.39-0.95). In contrast, in the older group there were 104 events in 819 treated patients (12.7%) vs 88 events in 823 untreated individuals (10.7%) (HR, 0.99; 95% CI, 0.59-1.33). CONCLUSIONS Treatment of SCH with levothyroxine was associated with fewer IHD events in younger individuals, but this was not evident in older people. An appropriately powered randomized controlled trial of levothyroxine in SCH examining vascular outcomes is now warranted.

Risk assessment of the subclinical hypothyroidism in non-alcoholic fatty liver disease patients with different levels of cardiovascular risk

“…Data of the analysis of 55,000 CHD patients had shown a confidence interval of 1.89 (95% CI 1.28-2.80) for coronary heart disease events in TSH levels above 10 mIU / l [5] compared with euthyroidism and 1, 58 (95% CI 1.10-2.27) for fatal CHD. These risks did not increase in subjects with TSH lower than 7 mIU /L, the mortality from all causes not increased with an increase in TSH.…”

“…Given the fact that according to prospective cohort studies an increase in the prevalence of MS components among adults with SH is observed [9], there is reason to assume potentiating influence on the formation of CVR both NAFLD and SH. The increasing of arteries intima-media thickness [6], predisposition to hypercoagulation, insulin resistance, oxidative stress [9] and endothelial dysfunction [5] also contributes to increase a CVR in SH. On the background of substitution therapy with Levothyroxine in patients with SH a decrease of carotid arteries intima-media thickness [6], an improvement of endothelial function [5], improvement of cardiac function [4] were observed.…”

“…The increasing of arteries intima-media thickness [6], predisposition to hypercoagulation, insulin resistance, oxidative stress [9] and endothelial dysfunction [5] also contributes to increase a CVR in SH. On the background of substitution therapy with Levothyroxine in patients with SH a decrease of carotid arteries intima-media thickness [6], an improvement of endothelial function [5], improvement of cardiac function [4] were observed. Such therapy may reduce the risk of coronary heart disease in relatively young patients with SH, but not in people aged over 70 years [8].…”

The application of normobaric hypoxytherapy for the subclinical hypothyroidism

“…Лечебная тактика у больных с манифестным ги-потиреозом достаточно четко определена, в то вре-мя как целесообразность заместительной терапии СГ препаратами тиреоидных гормонов до сих пор остается предметом дискуссий [6][7][8][9][10]. Поскольку основной задачей, стоящей перед врачом, является предупреждение прогрессии субклинического в ма-нифестный гипотиреоз, то особенно актуальным является поиск немедикаментозных методов лече-ния данной патологии.…”

Potential Thyrotropic and Antihypercholesteronemic Activity Exhibited by Ethanolic Extract of Crataeva nurvala Bark

“…Helicobacter pylori infection, celiac disease). The principal adverse consequences of overtreatment are TSH suppression cardiovascular risk, skeletal or high risk of fracture, especially postmenopausal women, however, bone density does not reduce on short term administration and possible affective disturbances (Rees-Jones and Larsen, 1977;Razvi et al, 2012;Schneider et al, 2012;Ross, 1993;Biondi et al, 1994;Botella-Carretero et al, 2003).…”