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The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

Johannes Wolfgang Dietrich1,2, Rudolf Hoermann3, John E M Midgley4

  • 1Endocrinology and Diabetes Department, Medical Hospital I, Bergmannsheil University Hospitals, Ruhr University of Bochum, Bochum, Germany.

Frontiers in Endocrinology
|November 16, 2020
PubMed

Insights

Psychosocial stress, like post-traumatic stress disorder (PTSD), is linked to altered thyroid function. This connection may increase cardiovascular risk through a higher thyroid-stimulating hormone (TSH) set point.

Area of Science:

  • Endocrinology
  • Psychoneuroendocrinology
  • Cardiovascular Risk Factors

Background:

  • Elevated free thyroid hormones are known cardiovascular risks, but thyrotropin (TSH) associations are less clear.
  • TSH secretion is influenced by confounders like genetics, medication, and allostatic load, particularly psychosocial stress.
  • Psychosocial stress can alter the thyroid function set point, impacting thyroid homeostasis.

Purpose of the Study:

  • To systematically meta-analyze published studies on thyroid function in post-traumatic stress disorder (PTSD).
  • To investigate the association between PTSD, allostatic load, and thyroid function markers.
  • To explore the role of psychosocial stress in thyroid allostasis and cardiovascular risk.

Main Methods:

  • Systematic meta-analysis of published studies identified via MEDLINE/PubMed and reference lists.
  • Inclusion criteria: studies measuring TSH or free thyroid hormones in subjects with and without PTSD.
  • Re-analysis of NHANES 2007/2008 cohort data for correlation between allostatic load and thyroid homeostasis.

Main Results:

  • Evidence from 13 studies and 3386 euthyroid subjects shows a strong association between PTSD and allostatic load with thyroid function markers.
  • Findings suggest PTSD and allostatic load are linked to altered thyroid function.
  • TSH concentrations may be elevated due to factors other than subclinical hypothyroidism.

Conclusions:

  • Psychosocial stress, via increased allostatic load, may contribute to cardiovascular risk by elevating the thyroid homeostasis set point.
  • This highlights an understudied psychoendocrine axis.
  • Future research should integrate allostatic load indices, peripheral thyroid hormones, and thyroid homeostasis parameters.

Keywords:
allostatic loadmalignant arrhythmiapost-traumatic stress disorder (PTSD)subclinical hypothyroidismsudden cardiac deaththyroid homeostasisthyrotropin

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