Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Detectability of Subclinical Hypothyroidism and Thyroid Stimulating Hormone Levels Associated with Cardiovascular Diseases in Patients of North-West Region Hospital

https://doi.org/10.20996/1819-6446-2019-15-2-174-179

Full Text:

Abstract

Increased thyroid stimulating hormone (TSH) levels are detected quite often especially in older patients. Increased TSH level doesn't usually indicate the formation of persistent hypothyroidism and may be due to concomitant somatic disorders. Determining the threshold values of TSH associated with cardiovascular diseases (CVD) is an important clinical task.

Aim. To study the detectability of subclinical hypothyroidism, the range of thyroid-stimulating hormone values associated with CVD in patients who seek medical care at the multidisciplinary hospital of the North-West region.

Material and methods. 1340 patients of different sex and age with normal TSH value (0.4-2.5 mlU/l) and subclinical hypothyroidism were included into the study. Subclinical hypothyroidism was considered an increase in TSH level >4.0 mlU/L, provided that the level of free T4 is normal. According to electronic case histories in all patients, CVD (hypertension, coronary heart disease, heart failure, arterial atherosclerosis of the lower extremities) and a history of cardiovascular events (unstable angina, acute myocardial infarction, stroke and transient ischemic attack) were analyzed. For data processing the program Statistica, version 1 2 was used.

Results. The detectability of subclinical hypothyroidism was 1 0.2%, manifest hypothyroidism - 2.4%. In patients with subclinical hypothyroidism, CVD were detected significantly more often than in patients with euthyroidism (p<0.05). Subclinical hypothyroidism increased the likelihood of CVD in the middle age group (odds ratio [OR] 1.62; 95% confidence interval [95%CI] 1.39-1.89), in elderly patients (OR 3.84; 95%CI 2.95-4.99), and in patients 75 years and older (OR 2.53; 95%CI 1.84-3.50). Using the discriminant analysis, a mathematical model was built which allows predicting the development of CVD according to the TSH level of (accuracy - 66.7%, sensitivity - 22.3%, specificity - 96.8%). The estimated threshold TSH was 6.68 mlU/L. Patients with TSH levels <6.68 mlU/L have a high probability that they are healthy (96.8%), and elevated TSH levels (<6.68 mlU/L) are probably not associated with CVD.

Conclusion. An association of subclinical hypothyroidism with coronary heart disease, hypertension and CVD in general has been established. A TSH level of less than 6.68 mlU/L is probably not associated with CVD and does not require active treatment.

About the Authors

A. R. Volkova
Pavlov First Saint Petersburg State Medical University
Russian Federation

Anna R. Volkova - MD, PhD, Professor, Faculty Therapy Chair.

197022, Санкт-Петербург, ул. Льва Толстого, 6-8



O. D. Dygun
Pavlov First Saint Petersburg State Medical University
Russian Federation

Olga D. Dygun - MD, Associate Professor, Faculty Therapy Chair.

197022, Санкт-Петербург, ул. Льва Толстого, 6-8



O. N. Zhdanova
Pavlov First Saint Petersburg State Medical University
Russian Federation

Olga N. Zhdanova - MD, PhD, Associate Professor, Faculty Therapy Chair.

197022, Санкт-Петербург, ул. Льва Толстого, 6-8



B. G. Lukichev
Pavlov First Saint Petersburg State Medical University
Russian Federation

Boris G. Lukichev - MD, PhD, Professor, Chair of Propaedeutic of Internal Diseases.

197022, Санкт-Петербург, ул. Льва Толстого, 6-8



L. A. Belyakova
Pavlov First Saint Petersburg State Medical University
Russian Federation

Lyudmila A. Belyakova - PhD (Engineering Sciences), Senior Researcher, Department of Pharmacoepidemiology and Biomedical Statistics.

197022, Санкт-Петербург, ул. Льва Толстого, 6-8



E. M. Sereda
Pavlov First Saint Petersburg State Medical University
Russian Federation

Ekaterina M. Sereda - Resident, Faculty Therapy Chair.

197022, Санкт-Петербург, ул. Льва Толстого, 6-8



References

1. Volkova A.R., Dygun O.D., Katysheva N.S. et al. Methodological aspects of interpretation of thyroid-stimulating hormone reference intervals in the Northwest region megapolis hospital. Klinicheskaya Laboratornaya Diagnostika. 2018;63(9):538-42. (In Russ.) doi:10.18821/0869-2084-2018-63-9-538-542.

2. Podzolkov A.V., Fadeyev V.V. Hypothyroidism, Subclinical Hypothyroidism, High-normal TSH-level. Clinical and Experimental Thyroidology 2009;5(2):4-16 (In Russ.)

3. Surks M., Hollowell J. Age-Specific Distribution of Serum Thyrotropin and Antithyroid Antibodies in the U.S. Population: Implications for the Prevalence of Subclinical Hypothyroidism. The Journal of Clinical Endocrinology & Metabolism. 2007;92(12):4575-82. doi:10.1210/jc.2007-1499.

4. Tunbridge W.M., Evered D.C., Hall R. et al. The spectrum of thyroid disease in a community: the Whick-ham survey Clinical Endocrinology 1 977;7(6):481 -93. doi:10.1111/j.1365-2265.1977.

5. Rodondi N., Newman A., Vittinghoff E. et al. Subclinical Hypothyroidism and the Risk of Heart Failure, Other Cardiovascular Events, and Death. Archives of Internal Medicine. 2005;165(21):2460-6. doi: 10,1001/archinte.165.21.2460.

6. Canaris G., Manowitz N., Mayor G., Ridgway E. The Colorado Thyroid Disease Prevalence Study Archives of Internal Medicine. 2000;160(4):526-534. doi: 10,1001/archinte.160.4.526.

7. Braverman L.E., Cooper D.S. Werner & Ingbar's The Thyroid: A Fundamental and Clinical Text Tenth Edition. Wolters Kluwer: Lippincott Williams & Wilkins; 2012.

8. Hak A., Pols H., Visser T, Drexhage H. Subclinical Hypothyroidism Is an Independent Risk Factor for Atherosclerosis and Myocardial Infarction in Elderly Women: The Rotterdam Study Annals of Internal Medicine. 2000;132(4):270-8. doi:10.7326/0003-4819-132-4-200002150-00004.

9. . Ning Y, Cheng Y, Liu L. et al. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Medicine. 2017;15(1):21. doi:10.1186/s12916-017-0777-9.

10. Volkova A.R., Dora S.V, Berkovich O.A. et al. Subclinical hypothyroidism - new cardiovascular risk factor Terapiya. 2016;6:23-8. (In Russ.) [Волкова А.Р, Дора С.В., Беркович О.А. и др. Субклинический гипотиреоз - новый фактор сердечно-сосудистого риска. Терапия. 2016;6:23-8].

11. De Miranda E., Bittencourt M., Staniak H. et al. Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Braz J Med Biol Res. 2018;51(5):e7196. doi:10.1590/1414-431X20177196.

12. Delitala A., Filigheddu F, Orru M. et al. No evidence of association between subclinical thyroid disorders and common carotid intima medial thickness or atherosclerotic plaque. Nutrition, Metabolism and Cardiovascular Diseases. 2015;25(12):1 104-10. doi:10.1016/j.numecd.2015.09.001.

13. Garber J., Cobin R., Gharib H. et al. Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(1 2):1 200-35. doi:10.1089/thy.2012.0205.

14. Derwahl K.M., Duntas L.H., Butz S., eds. Thyroid and Cardiovascular Risk: Merck European Thyroid Symposium, Berlin, 10-13 June, 2004, 1st ed. Berlin: Thieme; 2005.

15. Wiersinga W.M. Guidance in Subclinical Hyperthyroidism and Subclinical Hypothyroidism: Are We Making Progress? European Thyroid Journal. 2015;4(3):143-8. doi:10.1159/000438909.

16. Redford C., Vaidya B. Subclinical hypothyroidism: Should we treat? Post Reproductive Health. 2017;23(2):55-62. doi:10.1177/2053369117705058.

17. Floriani C., Gencer B., Collet T, Rodondi N. Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update. Eur Heart J. 2017;39(7): 503-7. doi:10.1093/eurheartj/ehx050

18. Fadeyev V.V. Challenges in replacement therapy of hypothyroidism: everyday practice and perspectives. Clinical and Experimental Thyroidology 2012;8(3):17-29. (In Russ.)


For citation:


Volkova A.R., Dygun O.D., Zhdanova O.N., Lukichev B.G., Belyakova L.A., Sereda E.M. Detectability of Subclinical Hypothyroidism and Thyroid Stimulating Hormone Levels Associated with Cardiovascular Diseases in Patients of North-West Region Hospital. Rational Pharmacotherapy in Cardiology. 2019;15(2):174-179. (In Russ.) https://doi.org/10.20996/1819-6446-2019-15-2-174-179

Views: 153


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)