What is it about?
The diagnosis of subclinical thyroid diseases (SCTD) is biochemical, based on the finding of altered TSH in the presence of normal circulating levels of thyroid hormones, without symptoms of clinically manifest disease. Examining the association of SCTD with an increased risk of cardiovascular disease is still a major challenge, on the one hand, due to the complexity of the hypothalamic-pituitary-thyroid axis, and on the other hand because of nonspecific changes in SCHD that at the same time pose a risk factor for the development of cardiovascular diseases.
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Why is it important?
In overt forms of thyroid disease, there are changes in cardiovascular physiology and metabolic parameters that favor cardiovascular events, and the causal relationship between them and CVD is clear, but this relationship in subclinical forms of the disease, especially in subclinical hypothyroidism, is still unclear. A large number of studies and meta-analyses that have dealt with these issues show the existence of some association between SCHD and CVD, but not the causality of their connection, especially in subclinical hypothyroidism. On the other hand, there are numerous studies that do not find such a connection. While subclinical hyperthyroidism is more clearly associated with changes in cardiovascular physiology, and thus with a possible higher risk of cardiovascular events, especially in the elderly and people with pre-existing CVD, in subclinical hypothyroidism the changes are more subtle and this association is more obscure.
Perspectives
The clinical significance of SCTD lies in its high prevalence and the availability of therapy that can bring thyroid hormone status back to normal. But the question remains whether interfering with the "set up" of the hypothalamic-pituitary-thyroid axis brings any benefit to these patients. The guidelines are clearer for more severe forms of SCTD with TSH values below 0.1 mIU / L and above 10 mIU / L, while the mild forms of SCTD still remain to be monitored. In our paper, we have tried to present the results of studies and meta-analyses so far and to emphasize that, despite a large number of papers, the question of the connection between SCTD and the risk of CVD remains open.
Mirjana Stojković
Faculty of Medicine University of Belgrade
Read the Original
This page is a summary of: Subclinical Thyroid Dysfunction and the Risk of Cardiovascular Disease, Current Pharmaceutical Design, December 2020, Bentham Science Publishers,
DOI: 10.2174/1381612826666201118094747.
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