The Effect of Thyroid Stimulating Hormone Level Within the Reference Range on In-Hospital and Short-Term Prognosis in
Muhammet Gürdoğan1, Servet Altay2, Selçuk Korkmaz3
1Department of Cardiology, School of Medicine, Trakya University, 22030 Edirne, Turkey. drmgurdogan@gmail.com.
Insights
Even within normal limits, high-normal thyroid stimulating hormone (TSH) levels predict increased mortality in acute coronary syndrome (ACS) patients. This finding highlights TSH
Area of Science:
- Cardiology
- Endocrinology
- Clinical Medicine
Background:
- Thyroid stimulating hormone (TSH) levels, even within the normal range, can impact cardiovascular health.
- Most patients hospitalized with acute coronary syndrome (ACS) are euthyroid (normal thyroid function).
Purpose of the Study:
- To examine the association between TSH levels and prognosis in euthyroid patients with ACS during hospitalization and follow-up.
- To determine if TSH levels within the normal reference range influence cardiovascular outcomes in ACS patients.
Main Methods:
- A cohort of 629 euthyroid ACS patients with TSH levels between 0.3-5.33 uIU/mL was analyzed.
- Patients were stratified into three TSH tertiles: low-normal (<0.90 uIU/mL), mid-normal (0.90-1.60 uIU/mL), and high-normal (1.60-5.33 uIU/mL).
- Demographic, clinical, laboratory, and angiographic data were compared, and in-hospital and 6-month follow-up outcomes were assessed.
Main Results:
- Significant differences were observed between TSH tertiles regarding coronary artery disease severity, in-hospital mortality, major hemorrhage, and adverse clinical events.
- The high-normal TSH tertile was independently associated with increased cumulative mortality during the 6-month follow-up period.
- Multivariate analysis indicated the high-normal TSH tertile as a significant predictor of mortality (OR = 6.307).
Conclusions:
- A high-normal TSH level upon admission in euthyroid ACS patients is an independent predictor of 6-month total mortality.
- These findings suggest that TSH levels within the upper normal range warrant attention in ACS patient management.
- Further research may explore the clinical implications and potential interventions related to high-normal TSH levels in cardiovascular disease.
Abstract:
Background and objectives: Despite being within the normal reference range, changes in thyroid stimulating hormone (TSH) levels have negative effects on the cardiovascular system. The majority of patients admitted to hospital with acute coronary syndrome (ACS) are euthyroid. The aim of this study was to investigate the effect of TSH level on the prognosis of in-hospital and follow-up periods of euthyroid ACS patients. Materials and Methods: A total of 629 patients with acute coronary syndrome without thyroid dysfunction were included in the study. TSH levels of patients were 0.3-5.33 uIU/mL. Patients were divided into three TSH tertiles: TSH level between (1) 0.3 uIU/mL and <0.90 uIU/mL (n = 209), (2) 0.90 uIU/mL and <1.60 uIU/mL (n = 210), and (3) 1.60 uIU/mL and 5.33 uIU/mL (n = 210). Demographic, clinical laboratory, and angiographic characteristics were compared between groups in terms of in-hospital and follow-up prognosis. Results: Mean age was 63.42 ± 12.5, and 73.9% were male. There was significant difference between tertiles in terms of TSH level at admission (p < 0.001), the severity of coronary artery disease (p = 0.024), in-hospital mortality (p < 0.001), in-hospital major hemorrhage (p = 0.005), total adverse clinical event (p = 0.03), follow-up mortality (p = 0.022), and total mortality (p < 0.001). In multivariate logistic regression analysis, the high-normal TSH tertile was found to be cumulative mortality increasing factor (OR = 6.307, 95%; CI: 1.769-22.480; p = 0.005) during the 6-month follow-up period after hospitalization and discharge. Conclusions: High-normal TSH tertile during hospital admission in euthyroid ACS patients is an independent predictor of total mortality during the 6-month follow-up period after hospitalization and discharge.
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