The Beneficial Effect of<scp>l</scp>-Thyroxine on Cardiovascular Risk Factors, Endothelial Function, and Quality of Life in Subclinical Hypothyroidism: Randomized, Crossover Trial

Razvi, Salman; Ingoe, Lorna; Keeka, Gill; Oates, Crispian; McMillan, Carolyn; Weaver, Jolanta U.

doi:10.1210/jc.2006-1869

Cited by 367 publications

(354 citation statements)

References 38 publications

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“…6 Hypothyroidism may also lead to endothelial dysfunction, hypercoagulability, impaired fibrinolysis, hyperhomocysteinemia, systemic inflammation, and platelet abnormalities. 6 Importantly, many of the aforementioned alterations are reversible upon normalization of thyroid function 7 and may be observed even in patients with physiological variations of TSH 8 and fT4. 9 Whether these same notions hold true for fT3 as well has not been established, but in our population the prevalence of hypercholesterolemia and arterial hypertension did not vary according to fT3 levels.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Coceani

Iervasi

Pingitore

et al. 2009

Clinical Cardiology

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Background: Overt thyroid dysfunction, hypothyroidism in particular, may lead to coronary artery disease (CAD). Whether more subtle anomalies of thyroid hormone metabolism influence the progression of CAD remains a matter of speculation. Hypothesis: The occurrence of CAD and long-term prognosis in patients without a history of either primary thyroid disease, myocardial infarction, or chronic heart failure is related to serum levels of biologically active free triiodothyronine (fT3). Methods: The cohort consisted of 1047 clinically and biochemically euthyroid patients (median age 65.6 y and 69% male) who underwent coronary angiography in our institute for suspected CAD. Results: Lower fT3 levels were predictive of both single-vessel (p = 0.012) and multivessel (p = 0.009) CAD. Through a multivariate logistic regression analysis, fT3 was still linked to the presence of CAD (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.34-0.68, p < 0.001). After a mean follow-up of 31 months, the survival rate was 95% and total mortality (log-rank 6.75, p = 0.009), as well as cardiac mortality (log-rank 8.26, p = 0.004), was greater among patients with low T3 (fT3<2.10 pg/mL) syndrome. At subsequent multivariate Cox regression analysis, the association between low T3 syndrome and survival was maintained (total mortality HR: 1.80, 95% CI: 1.05-3.10, p = 0.034; cardiac mortality HR: 2.58, 95% CI: 1.13-5.93, p = 0.025). Conclusions:In this selected population, fT3 levels were inversely correlated to the presence of CAD and low T3 syndrome conferred an adverse prognosis, even after adjusting for traditional coronary risk factors.

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Section: Discussionmentioning

confidence: 99%

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Coceani

Iervasi

Pingitore

et al. 2009

Clinical Cardiology

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“…64 -66 Lipid profile changes are also evident in subclinical hypothyroidism. Specifically, some studies have demonstrated that LDL is increased in subclinical hypothyroidism and reversible with thyroid hormone replacement, 67,68 whereas other studies have shown increased total cholesterol in subclinical hypothyroidism with no changes in LDL. The reported mechanisms for the development of hypercholesterolemia in hypothyroidism include decreased fractional clearance of LDL by a reduced number of LDL receptors in the liver in addition to decreased receptor activity.…”

Section: Thyroid Hormone Effects On Lipid Metabolismmentioning

confidence: 99%

“…65,66 Lipid metabolism is altered in subclinical hypothyroidism. 64,67 Patients have increased serum lipid levels, and cholesterol levels appear to rise in parallel with serum TSH. 7,66 C-Reactive protein, a risk factor for heart disease, is increased in subclinical hypothyroidism.…”

Section: Subclinical Thyroid Diseasementioning

confidence: 99%

“…72,106 Although treatment of subclinical hypothyroidism with appropriate doses of L-thyroxine has been controversial, and a position paper found insufficient evidence to recommend treatment, 11 a recent study confirms the cardiovascular benefits of therapy. 67 As previously suggested, the benefits of the restoration of TSH levels to normal can be considered to outweigh the risks. 1…”

Section: Subclinical Thyroid Diseasementioning

confidence: 99%

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Thyroid Disease and the Heart

Klein¹,

Danzi²

2016

Current Problems in Cardiology

138

104

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Abstract-The cardiovascular signs and symptoms of thyroid disease are some of the most profound and clinically relevant findings that accompany both hyperthyroidism and hypothyroidism. On the basis of the understanding of the cellular mechanisms of thyroid hormone action on the heart and cardiovascular system, it is possible to explain the changes in cardiac output, cardiac contractility, blood pressure, vascular resistance, and rhythm disturbances that result from thyroid dysfunction. The importance of the recognition of the effects of thyroid disease on the heart also derives from the observation that restoration of normal thyroid function most often reverses the abnormal cardiovascular hemodynamics. In the present review, we discuss the appropriate thyroid function tests to establish a suspected diagnosis as well as the treatment modalities necessary to restore patients to a euthyroid state. We also review the alterations in thyroid hormone metabolism that accompany chronic congestive heart failure and the approach to the management of patients with amiodarone-induced alterations in thyroid function tests.

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“…Finally, Razvi et al 11 have recently suggested that L-T4 replacements improve cardiovascular risk factors and endothelial function in subclinical hypothyroidism. However, it is still not clear whether the normalization of subclinical thyroid dysfunction leads to a change in blood pressure.…”

mentioning

confidence: 99%

Does subclinical thyroid dysfunction affect blood pressure?

Nakata

2011

Hypertens Res

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A highly sensitive immunoassay for thyroid-stimulating hormone (TSH) was developed in the 1980's for the diagnosis of patients with subclinical thyroid dysfunctions. The frequency of subclinical hypothyroidism is 4.3-11.8% and that of subclinical hyperthyroidism is 0.7-1.5%. 1 An association between subclinical hypothyroidism and cardiovascular risks and the development of atherosclerosis has been reported. 2 Subclinical hyperthyroidism reportedly increases heart rate, the frequency of arrhythmia (including atrial fibrillation), left ventricular mass and the risk of cardiovascular mortality; it also impairs ventricular relaxation. 3 However, the relationship between subclinical thyroid dysfunction and hypertension has remained controversial.In this issue, Cai et al. 4 report the result of a meta-analysis, in which they aimed to determine whether subclinical thyroid dysfunction affects blood pressure. Their findings indicate that subclinical hypothyroidism is associated with a significant risk of increased blood pressure, both systolic and diastolic blood pressure, whereas subclinical hyperthyroidism is not associated with increased blood pressure. 4 They suggest that the controversy regarding the relationship between subclinical hypothyroidism and hypertension may derive from the small number of subjects in the case-control studies, selection bias, or differences in race, lifestyle and genetic background among the sampled population. 4 We need to consider several aspects of thyroidology and laboratory medicine as factors that affected the analysis of the results. These aspects can be divided into the following four concepts.

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The Beneficial Effect ofl-Thyroxine on Cardiovascular Risk Factors, Endothelial Function, and Quality of Life in Subclinical Hypothyroidism: Randomized, Crossover Trial

Abstract: SCH treated by L-thyroxine leads to a significant improvement in CV risk factors and symptoms of tiredness. The CV risk factor reduction is related to the increased level of achieved free T(4) concentration.

Cited by 367 publications

References 38 publications

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Thyroid Hormone and Coronary Artery Disease: From Clinical Correlations to Prognostic Implications

Thyroid Disease and the Heart

Does subclinical thyroid dysfunction affect blood pressure?

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