Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update.

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State: Serval
Version: Author's accepted manuscript
Serval ID
serval:BIB_F00C1BA42D70
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Subclinical thyroid dysfunction and cardiovascular diseases: 2016 update.
Journal
European heart journal
Author(s)
Floriani C., Gencer B., Collet T.H., Rodondi N.
ISSN
1522-9645 (Electronic)
ISSN-L
0195-668X
Publication state
Published
Issued date
14/02/2018
Peer-reviewed
Oui
Volume
39
Number
7
Pages
503-507
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Subclinical thyroid dysfunction comprises subclinical hypothyroidism (SHypo), defined as elevated thyroid-stimulating hormone (TSH) by normal free thyroxine (FT4), and subclinical hyperthyroidism (SHyper) with decreased or undetectable TSH and normal FT4. Up to 10% of the elderly have SHypo, which is usually asymptomatic. Individual participant data (IPD) analyses of prospective cohort studies from the international Thyroid Studies Collaboration show that SHypo is associated with increased coronary heart disease (CHD) mortality [hazard ratio (HR) 1,58 for TSH ≥ 10 mIU/L, 95% CI 1.10-2.27), as well as increased risk of stroke, and heart failure (HF) for both higher and lower TSH. Small studies found that SHypo affects carotid intima media thickness (CIMT), diastolic function, peripheral vascular resistance, endothelial function, and lipid profile. SHyper is associated with increased risk of atrial fibrillation (AF) (HR 1.68, 95% CI 1.16-2.43) and CHD events (HR 1.21, 95% CI 0.99-1.46). The TSH threshold for initiating treatment is unclear. In the absence of large randomized controlled trials, the best evidence suggests SHypo therapy should be started at TSH ≥ 10 mIU/L, and SHyper therapy at TSH < 0.1 mIU/L. Recommendations on screening are discordant, but most guidelines advocate that thyroid function should be checked in those at risk for hypothyroidism, those over 60, and those with known CHD and HF. This review updates current evidence on the association between thyroid dysfunction and cardiovascular disease, as well as on screening and treatment of subclinical thyroid dysfunction.

Keywords
Cardiovascular diseases, Screening, Subclinical hyperthyroidism, Subclinical hypothyroidism, TSH, Treatment
Pubmed
Web of science
Open Access
Yes
Create date
28/03/2017 17:25
Last modification date
09/05/2019 3:14
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