Hypothyroidism and the heart

Česká verzia

Authors: J. Jiskra
Authors place of work: III. interní klinika 1. LF UK a VFN v Praze
Published in the journal: Kardiol Rev Int Med 2018, 20(3): 173-177

Summary

Hypothyroidism is often found in patients with cardiovascular disease; it is a risk factor for atherosclerosis and ischaemic heart disease and has a negative impact on left and right ventricle function (hypothyroid cardiomyopathy). Overt hypothyroidism is always treated with levothyroxine replacement. In patients with coincident cardiovascular disease, the treatment starts with a low dose of levothyroxine, which is increased gradually. In subclinically hypothyroid patients with cardiovascular disease, the levothyroxine replacement remains controversial and its benefits probably depend on the patient’s age. As the risk/benefit ratio often increases in the elderly, we are usually satisfied with target TSH in the upper part of the reference range or slightly above. With some simplification we can say that the best risk/benefit ratio of levothyroxine replacement in subclinical hypothyroidism is in cardiovascular patients aged 45–65.

Key words:

hypothyroidism – subclinical hypothyroidism – cardiovascular risk – ischaemic heart disease – left ventricle failure – right ventricle failure

Zdroje

1. Franklyn JA. The thyroid-too much and too little across the ages. The consequences of subclinical thyroid dysfunction. Clin Endocrinol (Oxf) 2013; 78(1): 1– 8. doi: 10.1111/ cen.12011.

2. Mariotti S. Mild hypothyroidism and ischemic heart disease: Is age the answer? J Clin Endocrinol Metab 2008; 93(8): 2969– 2971. doi: 10.1210/ jc.2008-1237.

3. Ochs N, Auer R, Bauer DC et al. Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann Intern Med 2008; 148(11): 832– 845.

4. Singer RB. Mortality in a complete 4year follow up of 85yearold residents of leiden, classified by serum level of thyrotropin and thyroxine. J Insur Med 2006; 38(1): 14– 19.

5. Stott DJ, Rodondi N, Kearney PM et al. TRUST Study Group. Thyroid hormone therapy for older adults with subclinical hypothyroidism. N Engl J Med 2017; 376(26): 2534– 2544. doi: 10.1056/ NEJMoa1603825.

6. Iqbal A, Jorde R, Figenschau Y. Serum lipid levels in relation to serum thyroidstimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism: the tromso Study. J Intern Med 2006; 260(1): 53– 61. doi: 10.1111/ j.1365-2796.2006.01652.x.

7. Abreu IM, Lau E, de Sousa Pinto B et al. Subclinical hypothyroidism: to treat or not to treat, that is the question! A systematic review with meta-analysis on lipid profile. Endocr Connect 2017; 6(3): 188– 199. doi: 10.1530/ EC-17-0028.

8. Biondi B, Galderisi M, Pagano L et al. Endothelial-mediated coronary flow reserve in patients with mild thyroid hormone deficiency. Eur J Endocrinol 2009; 161(2): 323– 329. doi: 10.1530/ EJE-09-0196.

9. Razvi S, Ingoe L, Keeka G et al. The beneficial effect of lthyroxine on cardiovascular risk factors, endothelial function and quality of life in subclinical hypothyroidism: randomised, crossover trial. J Clin Endocrinol Metab 2007; 92(5): 1715– 1723. doi: 10.1210/ jc.2006-1869.

10. Shakoor SK, Aldibbiat A, Ingoe LE et al. Endothelial progenitor cells in subclinical hypothyroidism: the effect of thyroid hormone replacement therapy. J Clin Endocrinol Metab 2010; 95(1): 319– 322. doi: 10.1210/ jc.2009-1421.

11. Curotto Grasiosi J, Peressotti B, Machado RA et al. Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism. Endocrinol Nutr 2013; 60(8): 427– 432. doi: 10.1016/ j.endonu.2013.01.013.

12. Monzani F, Di Bello V, Caraccio N et al. Effect of levothyroxine on cardiac function and structure in subclinical hypothyroidism: a double blind, placebo-controlled study. J Clin Endocrinol Metab 2001; 86(3): 1110– 1115. doi: 10.1210/ jcem.86.3.7291.

13. Turhan S, Tulunay C, Ozduman Cin M et al. Effects of thyroxine therapy on right ventricular systolic and diastolic function in patients with subclinical hypothyroidism: a study by pulsed wave tissue Doppler imaging. J Clin Endocrinol Metab 2006; 91(9): 3490– 3493. doi: 10.1210/ jc.2006-0810.

14. Nyirenda MJ, Clark DN, Finlayson AR et al. Thyroid disease and increased cardiovascular risk. Thyroid 2005; 15(7): 718– 724. doi: 10.1089/ thy.2005.15.718.

15. Andersen MN, Olsen AM, Madsen JC et al. Levothyroxine substitution in patients with subclinical hypothyroidism and the risk of myocardial infarction and mortality. PLoS One 2015; 10(6):e0129793. doi: 10.1371/ journal.pone.0129793.

16. Andersen MN, Olsen AS, Madsen JC et al. Long-term outcome in levothyroxine treated patients with subclinical hypothyroidism and concomitant heart disease. J Clin Endocrinol Metab 2016; 101(11): 4170– 4177. doi: 10.1210/ jc.2016-2226.

17. Blum MR, Gencer B, Adam L et al. Impact of thyroid hormone therapy on atherosclerosis in the elderly with subclinical hypothyroidism: a randomized trial. J Clin Endocrinol Metab 2018. doi: 10.1210/ jc.2018-00279.

18. Hollowell JG, Staehling NW, Flanders WD et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87(2): 489– 499. doi: 10.1210/ jcem.87.2.8182.

19. Garber JR, Cobin RH, Gharib H et al. American Association Of Clinical Endocrinologists and American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid 2012; 22(12): 1200– 1235. doi: 10.1089/ thy.2012.0205.

20. Boucai L, Hollowell JG, Surks MI. An approach for development of age-, gender-, and ethnicity-speciﬁc thyrotropin reference limits. Thyroid 2011; 21(1): 5– 11. doi: 10.1089/ thy.2010.0092.

21. Somwaru LL, Rariy CM, Arnold AM et al. The natural history of subclinical hypothyroidism in the elderly: the cardiovascular health study. J Clin Endocrinol Metab 2012; 97(6): 1962– 1969. doi: 10.1210/ jc.2011-3047.

22. Roos A, Linn-Rasker SP, van Domburg R et al. The starting dose of levothyroxine in primary hypothyroidism treatment: a prospective, randomized, bouble-blind trial. Arch Intern Med 2005; 165(15): 1714– 1720. doi: 10.1001/ archinte.165.15.1714.

23. Harjai KJ, Licata AA. Effects of amiodarone on thyroid function. Ann Intern Med 1997; 126(1): 63– 73.