Subclinical hypothyroidism, lipid metabolism and cardiovascular disease

Delitala, Alessandro; Fanciulli, Giuseppe; Maioli, Margherita; Delitala, G.

doi:10.1016/j.ejim.2016.12.015

Cited by 109 publications

(108 citation statements)

References 98 publications

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“…However, it has not been elucidated whether patients with subclinical hypothyroidism should be treated with thyroid hormones because administration of exogenous thyroid hormones can easily produce iatrogenic subclinical hyperthyroidism with AF 17. Also, previous studies have provided no clear evidence that additional thyroid hormone therapy in subjects with milder forms of subclinical hypothyroidism could improve lipid status and other cardiovascular risk factors,18 as well as symptoms associated with hypothyroidism 19. Alternatively, because hypothyroidism enhances atrial fibrosis, leading to increased AF substrate,6 adjunctive ablation strategies, such as ablation targeting low‐voltage areas,14, 20 may improve the atrial tachyarrhythmia–free survival in this subset of the patients.…”

Section: Discussionmentioning

confidence: 99%

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

Morishima

Okumura²,

Morita

et al. 2018

JAHA

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BackgroundHypothyroidism has been shown to contribute to enhanced atrial arrhythmogenesis, resulting in atrial fibrillation (AF) development in animal models and clinical populations. We aimed to elucidate whether high thyroid‐stimulating hormone (TSH) levels are related to outcomes of catheter ablation of AF.Methods and ResultsOf 477 consecutive patients who underwent first‐time pulmonary vein isolation–based radiofrequency catheter ablation of AF, 456 with TSH above the lower limit of the normal range (age, 65.5±9.9 years; men, 73.9%; paroxysmal AF, 56.8%) were analyzed for this study. Atrial tachyarrhythmia recurrence for 3 years was compared across groups with hypothyroidism (n=23) and TSH quartile groups with euthyroidism (normal‐range TSH levels, n=433). Atrial tachyarrhythmia recurrence occurred in 179 patients (39%) after the first session. Patients with hypothyroidism had increased recurrence compared with patients with normal TSH levels (crude hazard ratio, 3.14 after the last session; P=0.001). When focusing on patients with normal TSH levels, recurrence‐free survivals after both the first and last sessions were significantly reduced in euthyroid patients with the highest quartile of TSH levels (quartile 4) compared with others (quartiles 1–3). Cox regression analysis identified high TSH levels as an independent predictor of atrial tachyarrhythmia recurrence after both the first (adjusted hazard ratio, 1.51; P=0.018) and last (adjusted hazard ratio, 1.86; P=0.023) sessions. The difference was more pronounced in patients with paroxysmal AF than in those with nonparoxysmal AF.ConclusionsNot only hypothyroidism but also high‐normal TSH levels may be an independent predictor of atrial tachyarrhythmia recurrence after catheter ablation of AF.

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Section: Discussionmentioning

confidence: 99%

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

Morishima

Okumura²,

Morita

et al. 2018

JAHA

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“…No effect of prolonged L-T4 treatment on bone mass was observed in premenopausal women with reduced serum TSH in a meta-analysis report, whereas postmenopausal women with subclinical hyperthyroidism due to TSH-suppressive doses of L-T4 had reduced bone mass [80]. In postmenopausal women on L-T4 therapy, bone turnover is related to serum TSH concentration the reduction of L-T4 dose is beneficial to BMD and bone turnover [81], whereas L-T4 doses able to suppress TSH without inducing subclinical hyperthyroidism did not induce adverse effects on BMD [82]. Lack of effect on BMD of long-term therapy with L-T4 TSH suppressive for DTC was also reported both in premenopausal and postmenopausal women [83].…”

Section: Exogenous Subclinical Hyperthyroidismmentioning

confidence: 96%

Thyroid Hormone Diseases and Osteoporosis

Delitala

Scuteri

Doria

2020

JCM

126

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Thyroid hormones are essential for normal skeletal development and normal bone metabolism in adults but can have detrimental effects on bone structures in states of thyroid dysfunction. Untreated severe hyperthyroidism influences the degree of bone mass and increases the probability of high bone turnover osteoporosis. Subclinical hyperthyroidism, defined as low thyrotropin (TSH) and free hormones within the reference range, is a subtler disease, often asymptomatic, and the diagnosis is incidentally made during screening exams. However, more recent data suggest that this clinical condition may affect bone metabolism resulting in decreased bone mineral density (BMD) and increased risk of fracture, particularly in postmenopausal women. The main causes of exogenous subclinical hyperthyroidism are inappropriate replacement dose of thyroxin and TSH suppressive L-thyroxine doses in the therapy of benign thyroid nodules and thyroid carcinoma. Available data similarly suggest that a long-term TSH suppressive dose of thyroxin may decrease BMD and may induce an increased risk of fracture. These effects are particularly observed in postmenopausal women but are less evident in premenopausal women. Overt hypothyroidism is known to lower bone turnover by reducing both osteoclastic bone resorption and osteoblastic activity. These changes in bone metabolism would result in an increase in bone mineralization. At the moment, there are no clear data that demonstrate any relationship between BMD in adults and hypothyroidism. Despite these clinical evidences, the cellular and molecular actions of thyroid hormones on bone structures are not complete clear.

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“…Abnormal levels of cholesterol, triacylglycerol, or free fatty acids (FFA) in blood or peripheral tissues are significant features of lipid metabolic disorders. Dysregulation of lipid metabolism has been verified as the main cause of many diseases, including obesity, nonalcoholic fatty liver disease (NAFLD), cardiovascular diseases, insulin resistance, hypertension, and atherosclerosis . Therefore, investigation of the maintenance of lipid metabolism homeostasis is of great significance for the prevention and therapy of metabolic disorders.…”

Section: Introductionmentioning

confidence: 99%

Beneficial Effects of Pomegranate on Lipid Metabolism in Metabolic Disorders

Hou

Zhang

et al. 2019

Molecular Nutrition Food Res

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Pomegranate (Punica granatum Linn) is used in the prevention and treatment of metabolic syndrome in recent decades. Imbalances in lipid metabolism are profound features of metabolic disorders. In vivo and in vitro studies have shown that extracts of different pomegranate fractions (peels, flowers, juice, and seeds) regulate lipid metabolism in metabolic‐disorder‐associated diseases such as atherosclerosis, nonalcoholic fatty liver disease, and type 2 diabetes, helping to alleviate the development of diseases. Amelioration of oxidative stress and the inflammatory response is considered an important reason underlying the regulation of lipid metabolism by pomegranate extracts. Mitochondria, the major cellular site for lipid oxidation, are strongly associated with cellular oxidative and inflammatory status and are likely to be a target for pomegranate extract action. This review summarizes the main findings about the effects of different pomegranate fraction extracts on lipid metabolism in metabolic‐disorder‐associated diseases and analyses how pomegranate extracts achieve their effects. Furthermore, it also provides an important basis for the research and development of pomegranate‐related nutrients or drugs.

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Subclinical hypothyroidism, lipid metabolism and cardiovascular disease

Cited by 109 publications

References 98 publications

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

High‐Normal Thyroid‐Stimulating Hormone Shows a Potential Causal Association With Arrhythmia Recurrence After Catheter Ablation of Atrial Fibrillation

Thyroid Hormone Diseases and Osteoporosis

Beneficial Effects of Pomegranate on Lipid Metabolism in Metabolic Disorders

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