Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery

Kim, Hana; Kong, Sung Hye; Moon, Jae Hoon; Kim, Sang Yoon; Park, Kay-Hyun; Kim, Jun Sung; Choh, Joong Haeng; Park, Young Joo; Lim, Cheong

doi:10.3803/enm.2020.35.2.308

Cited by 12 publications

(11 citation statements)

References 31 publications

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“…Previous studies have reported increased mortality, Af, and stroke rates [5][6][7], and repeat target-vessel PCI [6] in patients with hypothyroidism who underwent CABG, and their findings were different from our results. These studies are single-center retrospective reviews that confirmed the diagnosis by routine screening of the serum levels of TSH, T3, and T4 and clinical symptoms described in medical records.…”

Section: Discussioncontrasting

confidence: 99%

“…Patients with advanced coronary artery disease (CAD) require a coronary artery bypass grafting (CABG). Some single-center retrospective clinical studies on the long-term prognosis of patients with hypothyroidism who underwent CABG have revealed a higher risk of revascularization, atrial fibrillation, and all-cause mortality [5][6][7] and increased risk of renal replacement therapy [4]. The exact physiology of thyroid disease and the relationship with post-CABG prognosis remain unclear.…”

Section: Introductionmentioning

confidence: 99%

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Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study

Lin

Kao

Tsai

et al. 2022

JCM

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Background: Some research indicated that hypothyroidism has huge adverse effects for the metabolic, cardiovascular, respiratory, and immune systems. However, there is no confirmed conclusion for the effect of cardiovascular surgery. This cohort study aims to investigate the prognosis of hypothyroidism patient at the age under 65-year-old after coronary artery bypass grafting (CABG) surgery. Method: From the National Health Insurance Research Database of Taiwan, 1586 patients with hypothyroidism who underwent elective CABG surgery were selected, along with 6334 patients who underwent surgery in a ratio of 1:4 sex-, age- and index year-matched controls, who were out of hypothyroidism. We used Cox proportional hazard analysis to compare the rate of 30-day, 5-year mortality, post-operative atrial fibrillation, respiratory complication during an average of 10-year follow-up. Result: Post-CABG patients had more hospital days, which was associated with hypothyroidism, male, DM and higher CCI_R (p < 0.001). Post-CABG patients had more inpatient respiratory complications, which was associated with hypothyroidism (p = 0.041), DM and CCI_R (p < 0.001, p = 0.046), and there was no difference in 1-year respiratory complication, tracheostomy in the same hospital course and within 1 year, repeated PCI, Af, CVVH, cerebral infarction, 30-day and 5-year mortality rate. Conclusions: Hypothyroidism correlates to post-CABG ventilator-related complications and pneumonia, and prolonged hospital days, but no effect on 30-day, 5-year mortality, post-operative atrial fibrillation and cerebral infarction rate. Thyroid function survey might include routinely preoperative survey for CABG outcome prognosis.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study

Lin

Kao

Tsai

et al. 2022

JCM

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“…The heterogeneity between studies was moderate to substantial in the meta-analysis for subclinical hypothyroidism (42,121,123,126,130,131,136,(140)(141)(142)(143). Random effects models reveal an association to inclusive MACE, but not to study-specific MACE (Figures 8A,B).…”

Section: Outcome Main Resultsmentioning

confidence: 99%

“…In subjects with heart failure elevated TSH concentration was associated with increased hazard ratio for a composite end point ( 131 ). Patients undergoing cardiac surgery with ischaemic heart disease demonstrated elevated TSH concentration to be associated with higher all-cause and cardiovascular mortality ( 136 ).…”

Section: Clinical Evidencementioning

confidence: 99%

Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence

Müller

Leow

Dietrich

2022

Front. Cardiovasc. Med.

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It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.

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“…Several studies found correlations between sHypo and cardiovascular disease [ 75 , 76 ], including a comprehensive meta-analysis that demonstrated an association between cardiovascular disease risk and sHypo [ 77 ]. Long-term cardiovascular outcomes after coronary bypass grafting in patients with sHypo showed a poor prognosis [ 78 ]. However, data from a consortium of cohort studies with data from more than 75,000 participants (Thyroid Studies Collaboration) revealed no correlation with the risk of atrial fibrillation [ 79 ], heart failure [ 80 ], stroke [ 81 ], coronary heart disease [ 82 ], mortality [ 83 ], and sHypo.…”

Section: Organ-specific Considerations In the Management Of Shypomentioning

confidence: 99%

Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape

Yoo

Chung

2021

Endocrinol Metab

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Subclinical hypothyroidism (sHypo) is defined as normal serum free thyroid hormone levels coexisting with elevated serum thyroidstimulating hormone (TSH) levels. sHypo is a common condition observed in clinical practice with several unique features. Its diagnosis should be based on an understanding of geographic and demographic differences in biochemical criteria versus a global reference range for TSH that is based on the 95% confidence interval of a healthy population. During the differential diagnosis, it is important to remember that a considerable proportion of sHypo cases are transient and reversible in nature; the focus is better placed on persistent or progressive forms, which mainly result from chronic autoimmune thyroiditis. Despite significant evidence documenting the health impacts of sHypo, the effects of levothyroxine treatment (LT4-Tx) in patients with sHypo remains controversial, especially in patients with grade 1 sHypo and older adults. Existing evidence suggests that it is reasonable to refrain from immediate LT4-Tx in most patients if they are closely monitored, except in women who are pregnant or in progressive cases. Future research is needed to further characterize the risks and benefits of LT4-Tx in different patient cohorts.

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Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery

Cited by 12 publications

References 31 publications

Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study

Hypothyroidism Is Correlated with Ventilator Complications and Longer Hospital Days after Coronary Artery Bypass Grafting Surgery in a Relatively Young Population: A Nationwide, Population-Based Study

Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence

Subclinical Hypothyroidism: Prevalence, Health Impact, and Treatment Landscape

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