Risk for Ischemic Heart Disease and All-Cause Mortality in Subclinical Hypothyroidism

Imaizumi, Misa; Akahoshi, Masazumi; Ichimaru, Shinichiro; Nakashima, Eiji; Hida, Ayumi; Soda, Midori; Usa, Toshiro; Ashizawa, Kiyoto; Yokoyama, Naokata; Maeda, Renju; Nagataki, Shigenobu; Eguchi, Katsumi

doi:10.1210/jc.2003-031089

Cited by 334 publications

(300 citation statements)

References 29 publications

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“…There are some other reports that studied in smaller number of patients with dyslipidemia and reported 6.8% (2.2% and 4.6%, overt hypothyroidism and subclinical hypothyroidism, respectively) in United Kingdom [6], 7.8% (2.5% and 5.3%) in United States [7], and 7.2% (2.8% and 4.4%) in Greece [9]. Thus, the percentage in our study was comparable to previous studies in the subjects with dyslipidemia, but not as high as that in the studies recently reported in Japanese population [25,26]. Several reasons can be described.…”

Section: Discussionsupporting

confidence: 85%

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Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

et al. 2011

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abstract. Hypercholesterolemia is one of the most representative disorders of the common diseases. To evaluate the prevalence of hypothyroidism in the population of adult hypercholesterolemia, we prospectively examined the thyroid function in patients with untreated or treated hypercholesterolemia as a multi-center survey. Subjects were the patients who were treated with some antilipemic agents or the untreated patients whose total cholesterol (TC) was over 220 mg/dL and/or LDL-cholesterol (LDL-C) over 140 mg/dL. Among 737 cases recruited, 725 cases (300 males and 425 females) participated in the survey including the thyroid function test. The patient's backgrounds include hypertension (51%), diabetes mellitus (49%), fatty liver (17%), smoking (15%), and habitual drinking (10%). The 72% of the patients were treated with some antilipemic agents and the mean values of TC, LDL-C, triglyceride (TG), HDL-cholesterol (HDL-C), and LDL-C/HDL-C ratio were 204.5 mg/dL, 119.6 mg/dL, 144.4 mg/dL, 60.7 mg/dL and 2.25, respectively. The primary hypothyroidism was seen in 27 cases (3.7%) (11 males, 16 females) with subclinical hypothyroidism in 17 cases (2.4%) and overt hypothyroidism in 10 cases (1.4%). The central hypothyroidism was seen in 4 cases (0.6%). The prevalence of hypothyroidism was 4.3% in patients with hypercholesterolemia. Taking account of the large number of patients with dyslipidemia and importance of avoiding unnecessary administration and associated adverse effects, evaluation of the thyroid function could be warranted in patients with dyslipidemia although cost-benefit issues waits further investigation.Key words: Hypercholesterolemia, Dyslipidemia, Subclinical hypothyroidism strongly related to atherosclerotic cardiovascular disease. Recently, new therapeutic reagents such as fibrates and statins have been created and primary dyslipidemia is effectively treated with these reagents [1]. However, they are not low priced and may induce rare but serious side effects such as rhabdomyolysis [1]. Hypothyroidism induces secondary hypercholesterolemia that increases the incidence of atherosclerotic cardiovascular events [2], and replacement of low-

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Section: Discussionsupporting

confidence: 85%

“…Several reasons can be described. First of all, we performed multi-center study whose institutions distribute all over Japan, whereas Nagasaki [25] or Suita [26] is a single city. In addition, there are some resources to obtain the clinically important frequency of subclinical hypothyroidism in our study.…”

Section: Discussionmentioning

confidence: 99%

Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

et al. 2011

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“…In the last few years, an increased number of prospective population-based cohort studies (100,138,140,158,(161)(162)(163)(164)(165)(166)(167) (A,A,A,A,A,A,A,A,A,B,B), have reported conflicting results on the potential relationship bet ween SH and cardiovascular disease and mortality. These discrepancies may be due to differences in the populations studied in terms of age, sex, race/ethnicity, life style, TSH cutoffs, differences in confounders adjustments, follow-up period, and selection bias (1) (D).…”

Section: Is Subclinical Hypothyroidism Associated To Cardiovascular Rmentioning

confidence: 99%

Clinical practice guidelines for the management of hypothyroidism

Brenta

Vaisman

Sgarbi

et al. 2013

Arq Bras Endocrinol Metab

124

123

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Introduction: Hypothyroidism has long been known for its effects on different organ systems, leading to hypometabolism. However, subclinical hypothyroidism, its most prevalent form, has been recently related to cardiovascular risk and also to maternal-fetal complications in pregnant women. Objectives: In these clinical practice guidelines, several aspects of this field have been discussed with the clear objectives of helping physicians treat patients with hypothyroidism, and of sharing some of our Latin American-based clinical experience. Materials and methods: The Latin American Thyroid Society commissioned a Task Force on Hypothyroidism to develop evidence-based clinical guidelines on hypothyroidism. A systematic review of the available literature, focused on the primary databases of MedLine/PubMed and Lilacs/SciELO was performed. Filters to assess methodological quality were applied to select the best quality studies. The strength of recommendation on a scale from A-D was based on the Oxford Centre for Evidence--based Medicine, Levels of Evidence 2009, allowing an unbiased opinion devoid of subjective viewpoints. The areas of interest for the studies comprised diagnosis, screening, treatment and a special section for hypothyroidism in pregnancy. Results: Several questions based on diagnosis, screening, treatment of hypothyroidism in adult population and specifically in pregnant women were posed. Twenty six recommendations were created based on the answers to these questions. Despite the fact that evidence in some areas of hypothyroidism, such as therapy, is lacking, out of 279 references, 73% were Grade A and B, 8% Grade C and 19% Grade D. Conclusions: These evidence-based clinical guidelines on hypothyroidism will provide unified criteria for management of hypothyroidism throughout Latin America. Although most of the studies referred to are from all over the world, the point of view of thyroidologists from Latin America is also given. Arq Bras Endocrinol Metab. 2013;57(4):265-99

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“…Previous studies have shown unfavorable effects of overt or subclinical hypothyroidism (SCH; normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH)) on cardiovascular disease [1][2][3][4][5][6][7][8][9]. Some studies demonstrated the association of lipid abnormality and atherosclerosis with SCH or overt hypothyroidism.…”

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confidence: 99%

Favorable Influence of Subclinical Hypothyroidism on the Functional Outcomes in Stroke Patients

et al. 2010

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Abstract. Subclinical hypothyroidism (SCH) is thought to have an influence on stroke outcomes. However, few reports demonstrate a favorable relationship between the two. We evaluated this association in acute ischemic stroke. From Jan 2005 to Jun 2008, 756 acute ischemic stroke patients were recruited within seven days of onset. The patients with overt hypothyroidism/hyperthyroidism or other medical conditions that may affect thyroid function were excluded. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured within two days. Patients were divided into two groups: the SCH group (TSH > 5.0 μU/mL and normal FT4 levels) and the control group. Stroke outcomes were assessed using two different criteria. In the first outcome model, favorable outcomes [I] were simply defined by modified Rankin Scale (mRS) scores (≦ 1), while the favorable outcomes [II] were defined as follows: a) a mRS score of 0, if the baseline National Institute of Health Stroke Scale (NIHSS) scores were < 8, b) a mRS score of 0 or 1, if the NIHSS scores were 8-14, c) a mRS score 0-2, if the NIHSS scores were >14. The changes in mRS scores and the proportion of patients with favorable outcomes [I] p=0.003). We found that acute ischemic stroke patients with SCH at admission were more likely to show favorable functional outcomes than those without SCH. We can suggest preconditioning before the stroke combined with a reduced response to stress as a possible protective mechanism.

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Risk for Ischemic Heart Disease and All-Cause Mortality in Subclinical Hypothyroidism

Cited by 334 publications

References 29 publications

Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

Multi-center study on the prevalence of hypothyroidism in patients with hypercholesterolemia

Clinical practice guidelines for the management of hypothyroidism

Favorable Influence of Subclinical Hypothyroidism on the Functional Outcomes in Stroke Patients

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