Natural history of mild subclinical hypothyroidism in a middle-aged and elderly Chinese population: a prospective study

Li, Xiang; Zhen, Donghu; Zhao, Meng; Liu, Lu; Guan, Qingbo; Zhang, Haiqing; Ge, Shujian; Tang, Xulei; Gao, Ling

doi:10.1507/endocrj.ej16-0549

Cited by 20 publications

(11 citation statements)

References 41 publications

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“…Both SCH and hypercholesteremia increase the risk of cardiovascular events (3,22), and these two conditions can present simultaneously in many cases (3). Evidence from animal study has suggested that hypercholesteremia could influence thyroid function ( 23), and our previous population study also found that higher TC level was an independent risk factor of progression to OH in SCH patients (10). If the control of TC levels could also benefit thyroid function, this could be important to clinical practice and may be valuable to our management strategy of hypothyroidism.…”

Section: Discussionmentioning

confidence: 75%

“…In recent years, studies have revealed the emerging role of the disturbance of lipid metabolism in the development of hypothyroidism (4)(5)(6)(7)(8)(9). Our previous prospective observational study found that high baseline total cholesterol (TC) level was a risk factor of progression to OH in patients with SCH (10), which suggested that cholesterol may influence thyroid function. It is known that SCH is associated with an increased risk of cardiovascular disease (11,12), and cholesterol is a key element in the development of cardiovascular disease (13).…”

Section: Introductionmentioning

confidence: 99%

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Statin Use and Benefits of Thyroid Function: A Retrospective Cohort Study

Wang

Yuan

et al. 2021

Front. Endocrinol.

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PurposePrevious studies have suggested that cholesterol may influence thyroid function. Since statins are widely used for their cholesterol-lowering effect, we aimed to assess the association between statin use and thyroid function, and also to explore the role of the cholesterol-lowering effect in it.MethodsWe performed a retrospective cohort study derived from REACTION study. Eligible subjects receiving statin therapy were included in the statin group, and sex-, age-, total cholesterol (TC)-, and thyroid function-matched participants without lipid-lowering therapy were included in the control group. The median follow-up time was three years. Outcomes of thyroid function were evaluated at the end of follow-up. We used multivariable regression models to assess the association between statin use and outcomes of thyroid function, and also performed mediation analyses to explore the role of cholesterol in it.ResultsA total of 5,146 participants were screened, and 201 eligible subjects in the statin group and 201 well-matched subjects in the control group were analyzed. At the end of follow-up, TC and thyroid-stimulating hormone (TSH) levels in the statin group were lower than those in the control group (both p < 0.05), and the percentage of euthyroid subjects was higher in the statin group (88.06% vs. 76.12%, p = 0.002). The incidence rate of subclinical hypothyroidism (SCH) in euthyroid subjects was lower in the statin group (6.29% vs. 14.86%, p = 0.009), and the remission rate among subjects with SCH was higher in the statin group (50.00% vs. 15.38%, p = 0.008). In multivariable regression analyses, statin use was independently associated with lower TSH levels and higher odds to be euthyroid (OR 2.335, p = 0.004) at the end of follow-up. Mediation analyses showed the association between statin use and TSH levels were mediated by TC changes during follow-up.ConclusionStatin use was associated with benefits of thyroid function, and TC changes serve as a mediator of the association between statin use and TSH levels. Further studies are needed to clarify the possible underlying mechanism.

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Section: Discussionmentioning

confidence: 75%

Section: Introductionmentioning

confidence: 99%

Statin Use and Benefits of Thyroid Function: A Retrospective Cohort Study

Wang

Yuan

et al. 2021

Front. Endocrinol.

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“…e huge difference in normalization between Fade et al compared with Li et al and Somwaru et al could be explained in part by the difference in follow-up time, which was done just one year in the first study; in the other two, it was three and four years, respectively. Another notable difference is the sensitivity of the method used; in the study by Fade et al [13], it is only 0.1 mIU/L, whereas in the studies by Li et al [14], Rosário et al [15], and Somwaru et al [16], it is very similar 0.004 or 0.005 mIU/L. Focus on level, in Somwaru et al report [16], an increase in TSH normalization was observed in patients with less than 6.9 mIU/L TSH and without thyroid antibodies.…”

Section: Discussionmentioning

confidence: 94%

“…A number of different researchers have suggested a criterion for treatment but only when there are signs and if the TSH level is >10 mIU/L or >20 mIU/L [14]. In subjects of 60 years and older, some of the signs for Shypo are not as clearly diagnosed as in those under 60 years [32].…”

Section: Discussionmentioning

confidence: 99%

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TSH Levels in Subclinical Hypothyroidism in the 97.5th Percentile of the Population

Mayoral

Hernández-Huerta

Andrade

et al. 2020

International Journal of Endocrinology

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The debate regarding the cutoff point in the treatment of patients with subclinical hypothyroidism (Shypo) is ongoing. Generally, two different groups are identified for treatment by levels of 10 and 20 mIU/L. Nevertheless, the question remains, “what cutoff point should be chosen?” We have written a selective nonsystematic review focused on the 97.5 percentile reference value reported in healthy subjects in a number of countries and observed important disparities, which partly show the challenge of identifying a single cutoff point for those patients needing medication. We identified studies of TSH on the natural history of subclinical hypothyroidism from population-based prospective cohort studies, which follow up patients for several years. The evolution of TSH levels in these patients is variable. Some cases of TSH may return to lower levels at different stages over the years, but others may not, possibly even developing into overt thyroid failure, also variable. We analyzed factors that may explain the normalization of serum TSH levels. In addition, we found that thorough population-based prospective cohort studies following up on TSH levels, thyroid antibodies, and ultrasonography are important in decisions made in the treatment of patients. However, the 97.5 percentile reference value varies in different countries; therefore, an international cutoff point for subclinical hypothyroidism cannot be recommended.

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