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Author Spotlight: In Vivo Assessment of Thyroid Hormone Disruption Using the THAI Mouse Model
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Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update.

Carmen Floriani1, Baris Gencer2, Tinh-Hai Collet3,4

  • 1Department of General Internal Medicine, Inselspital, Bern University Hospital, Freiburgstrasse 8, 3010 Bern, Switzerland.

European Heart Journal
|March 23, 2017
PubMed
Summary
This summary is machine-generated.

Subclinical thyroid dysfunction, including subclinical hypothyroidism and hyperthyroidism, is linked to increased cardiovascular risks like heart disease and stroke. Treatment is recommended for thyroid-stimulating hormone (TSH) levels above 10 mIU/L or below 0.1 mIU/L.

Keywords:
Cardiovascular diseasesScreeningSubclinical hyperthyroidismSubclinical hypothyroidismTSHTreatment

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Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Epidemiology

Background:

  • Subclinical thyroid dysfunction, encompassing subclinical hypothyroidism (SHypo) and subclinical hyperthyroidism (SHyper), affects a significant portion of the elderly population.
  • SHypo is characterized by elevated thyroid-stimulating hormone (TSH) with normal free thyroxine (FT4), while SHyper presents with low or undetectable TSH and normal FT4.
  • Existing research suggests associations between subclinical thyroid dysfunction and various subclinical cardiovascular changes.

Purpose of the Study:

  • To review and update current evidence on the relationship between subclinical thyroid dysfunction and cardiovascular disease (CVD).
  • To examine the evidence regarding screening strategies for subclinical thyroid dysfunction.
  • To provide updated insights into the treatment thresholds for subclinical thyroid dysfunction.

Main Methods:

  • Individual participant data (IPD) analyses from prospective cohort studies within the international Thyroid Studies Collaboration.
  • Review of small studies investigating the impact of SHypo on cardiovascular markers.
  • Synthesis of current guidelines and evidence for screening and treatment recommendations.

Main Results:

  • SHypo is associated with increased coronary heart disease (CHD) mortality (HR 1.58 for TSH ≥ 10 mIU/L) and elevated risks of stroke and heart failure (HF).
  • SHypo impacts carotid intima media thickness (CIMT), diastolic function, endothelial function, and lipid profiles.
  • SHyper is linked to a higher risk of atrial fibrillation (AF) (HR 1.68) and CHD events (HR 1.21).

Conclusions:

  • Evidence supports initiating SHypo therapy at TSH ≥ 10 mIU/L and SHyper therapy at TSH < 0.1 mIU/L in the absence of large randomized trials.
  • Screening for thyroid function is recommended for individuals over 60, those at risk for hypothyroidism, and patients with known CVD, HF, or AF.
  • Subclinical thyroid dysfunction poses significant cardiovascular risks, necessitating careful consideration for screening and management.