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Aortic stiffness and left ventricular function in patients with differentiated thyroid cancer
A Gazdag1, E V Nagy2, A Erdei2
1Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary. annamaria.gazdag@gmail.com.
Journal of Endocrinological Investigation
|September 8, 2014
Summary
Thyroxine therapy in differentiated thyroid cancer patients increases aortic stiffness due to subclinical hyperthyroidism and hypothyroidism. Minimizing TSH suppression is advised, especially for those with cardiovascular conditions.
Area of Science:
- Cardiology
- Endocrinology
- Oncology
Background:
- Differentiated thyroid cancer (DTC) patients undergo total thyroidectomy and radioiodine ablation.
- Thyroxine (L-T4) therapy is used for TSH suppression, potentially leading to subclinical hyperthyroidism or hypothyroidism.
- Cardiovascular impact of these thyroid states requires investigation.
Purpose of the Study:
- To assess aortic stiffness and left ventricular (LV) function in DTC patients.
- To compare cardiovascular effects during TSH-suppressive L-T4 therapy versus after L-T4 withdrawal.
- To evaluate the impact of subclinical hyperthyroidism and overt hypothyroidism on cardiovascular parameters.
Main Methods:
- Studied 24 DTC patients on L-T4 therapy and after withdrawal.
- Measured aortic stiffness, LV dimensions, ejection fraction, and diastolic function (E'/A') via echocardiography.
- Assessed thyroid function, lipids, vWF, and fibrinogen, comparing to 22 healthy controls.
Main Results:
- Aortic stiffness was significantly increased in both hypothyroidism and subclinical hyperthyroidism compared to controls.
- Subclinical hyperthyroidism demonstrated a more pronounced increase in aortic stiffness.
- LV dimensions and ejection fractions remained similar; E'/A' was reduced in both thyroid states versus controls.
Conclusions:
- Long-term TSH suppression in DTC patients adversely affects the arterial wall.
- Cardiovascular risks associated with TSH suppression warrant careful consideration.
- Minimize TSH suppression to the lowest effective level, balancing benefits and risks, particularly in patients with cardiovascular comorbidities.
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