Subclinical hypothyroidism and cardiovascular risk: how to end the controversy

Rodondi, Nicolas; Bauer, Douglas C (2013). Subclinical hypothyroidism and cardiovascular risk: how to end the controversy. Journal of clinical endocrinology and metabolism, 98(6), pp. 2267-2269. Endocrine Society 10.1210/jc.2013-1875

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The indications for screening and TSH threshold levels for treatment of subclinical hypothyroidism have remained a clinical controversy for over 20 years. Subclinical thyroid dysfunction is a common finding in the growing population of older adults, occurring in 10–15% among those age 65 and older, and may contribute to multiple common problems of older age, including cardiovascular disease, muscular impairment, mood problems, and cognitive dysfunction (1). In 2004, both the U.S. Preventive Services Task Force (2) and a clinical consensus group of experts (3) concluded that the existing evidence about the association between subclinical hypothyroidism and cardiovascular risks, primarily cross-sectional or case-control studies (4), was insufficient. For example, a frequently cited analysis from the Rotterdam study found a cross-sectional association between subclinical hypothyroidism and atherosclerosis, as measured by abdominal aortic calcification (odds ratio, 1.7; 95% confidence interval [CI], 1.1–2.6) and prevalent myocardial infarction (MI) (odds ratio, 2.3; 95% CI, 1.3–4.0) (5). Conversely, the prospective part of this study included only 16 incident MIs; the hazard ratio (HR) for subclinical hypothyroidism was 2.50, with broad 95% CIs (0.70–9.10). Potential mechanisms for the associations with cardiovascular diseases among adults with subclinical hypothyroidism include elevated cholesterol levels, inflammatory markers, raised homocysteine, increased oxidative stress, insulin resistance, increased systemic vascular resistance, arterial stiffness, altered endothelial function, and activation of thrombosis and hypercoagulability that have all been reported to be associated with subclinical hypothyroidism (1, 6).

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Rodondi, Nicolas

Subjects:

600 Technology
600 Technology > 610 Medicine & health

ISSN:

0021-972X

Publisher:

Endocrine Society

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Patricia Rajaonina

Date Deposited:

03 Dec 2013 01:24

Last Modified:

19 Feb 2016 15:28

Publisher DOI:

10.1210/jc.2013-1875

PubMed ID:

23633199

BORIS DOI:

10.7892/boris.39368

URI:

https://boris.unibe.ch/id/eprint/39368

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