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Subclinical thyroid dysfunction and cardiovascular consequences: An alarming wake-up call?

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Summary

Subclinical thyroid dysfunction (STD), including hypothyroidism and hyperthyroidism, elevates cardiovascular risk. Treatment is recommended for severe cases due to potential benefits in reducing cardiac events and mortality.

Keywords:
AtherosclerosisAtrial fibrillationCardiac mortalityCardiovascular diseaseCoronary artery diseaseDyslipidemiaHeart failureHypertensionMyocardial infarctionStrokeSubclinical hyperthyroidismSubclinical hypothyroidismThyroid disease

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Area of Science:

  • Endocrinology
  • Cardiology
  • Internal Medicine

Background:

  • Subclinical thyroid dysfunction (STD), encompassing subclinical hypothyroidism (SHypo) and subclinical hyperthyroidism (SHyper), is characterized by abnormal thyrotropin (TSH) levels with normal free thyroid hormones.
  • STD is linked to increased cardiovascular (CV) risk, including atherosclerosis, coronary artery disease, heart failure, and atrial fibrillation, leading to higher CV and total mortality compared to euthyroid individuals.

Purpose of the Study:

  • To review the association between subclinical thyroid dysfunction and cardiovascular complications.
  • To discuss the mechanisms underlying the increased CV risk in SHypo and SHyper.
  • To evaluate the evidence for treating STD to mitigate CV risks.

Main Methods:

  • Review of existing evidence and observational studies on subclinical thyroid dysfunction and cardiovascular outcomes.
  • Analysis of differences in CV risk factors and mechanisms between SHypo and SHyper.
  • Assessment of current guidelines and expert opinions regarding treatment of STD.

Main Results:

  • Both SHypo and SHyper are associated with significant cardiovascular risks and increased mortality.
  • SHypo tends to cluster with more traditional CV risk factors, while TSH levels and subtle thyroid hormone changes impact the CV system in both conditions.
  • Observational data suggest treatment benefits, particularly for severe SHypo (TSH > 10 mIU/L) and grade 2 SHyper (TSH < 0.1 mIU/L).

Conclusions:

  • Subclinical thyroid dysfunction represents a significant, potentially alarming, risk factor for serious cardiovascular complications.
  • While definitive randomized controlled trials are lacking, accumulating evidence supports treatment for specific ranges of SHypo and SHyper to reduce CV morbidity and mortality.
  • Clinicians should be vigilant in identifying and managing STD due to its potential for adverse cardiovascular outcomes and the apparent benefits of treatment.