EVALUATING THYROID HORMONE INFLUENCE ON CARDIOVASCULAR RISK AMONG PATIENTS WITH SUBCLINICAL AND CLINICAL HYPOTHYROIDISM
DOI:
https://doi.org/10.71000/9jbp0544Keywords:
Atrial Fibrillation, Echocardiography, Cardiovascular Diseases, , Hypothyroidism, Lipid Metabolism, Risk Factors, Thyroid HormonesAbstract
Background: Thyroid hormones exert critical effects on cardiovascular physiology, and both subclinical and clinical hypothyroidism have been implicated in adverse cardiac outcomes. Evidence suggests varying degrees of cardiovascular risk depending on the stage of hypothyroidism, yet data from South Asian populations remain limited.
Objective: To assess how varying thyroid hormone levels influence cardiovascular health among patients with subclinical and clinical hypothyroidism.
Methods: This cross-sectional study was conducted over eight months at a tertiary care hospital in Lahore, Pakistan, involving 310 adults—155 with subclinical hypothyroidism and 155 with clinical hypothyroidism. Diagnosis was based on serum thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels. Cardiovascular assessment included clinical evaluation, electrocardiography, and echocardiography. Laboratory investigations comprised lipid profile and high-sensitivity C-reactive protein (hs-CRP). Statistical analyses were performed using t-tests, ANOVA, chi-square tests, and multiple linear regression, with p<0.05 considered significant.
Results: Participants with clinical hypothyroidism exhibited higher prevalence of left ventricular diastolic dysfunction (35.5% vs. 21.3%), systolic dysfunction (14.8% vs. 6.5%), and atrial fibrillation (12.3% vs. 8.4%) compared to subclinical cases. Elevated blood pressure was more frequent in the clinical group (45.8% vs. 32.9%). Total cholesterol and LDL-C were significantly higher in clinical hypothyroidism (228.5 mg/dL and 148.9 mg/dL) than in subclinical disease (210.4 mg/dL and 137.8 mg/dL). hs-CRP levels were also higher in the clinical group (4.1 mg/L vs. 3.4 mg/L).
Conclusion: Cardiovascular risk factors and structural abnormalities were more pronounced in clinical hypothyroidism, underscoring the need for proactive cardiovascular screening in all hypothyroid patients, with greater vigilance in overt disease.
References
Doshi M, Watanabe S, Natori Y, Hosoyamada M, Hirashima-Akae Y. Triiodothyronine Aggravates Global Cerebral Ischemia-Reperfusion Injury in Mice. Biol Pharm Bull. 2021;44(12):1824-31.
Papaleontiou M, Levine DA, Reyes-Gastelum D, Hawley ST, Banerjee M, Haymart MR. Thyroid Hormone Therapy and Incident Stroke. J Clin Endocrinol Metab. 2021;106(10):e3890-e900.
Liu J, Xue Y, Jiang W, Zhang H, Zhao Y. Thyroid Hormone Is Related to Postoperative AKI in Acute Type A Aortic Dissection. Front Endocrinol (Lausanne). 2020;11:588149.
Shreewastav RK, Dhungana SP, Pokhrel S, Jayshwal R, Pandey H. Thyroid Hormone Abnormalities and Associated Risk Factors among Acute Coronary Syndrome Patients at a Tertiary Care Hospital. Kathmandu Univ Med J (KUMJ). 2023;21(83):309-14.
Ellervik C, Boulakh L, Teumer A, Marouli E, Kuś A, Buch Hesgaard H, et al. Thyroid Function, Diabetes, and Common Age-Related Eye Diseases: A Mendelian Randomization Study. Thyroid. 2024;34(11):1414-23.
Chen Z, Wan H, Min T, Su S, Yang DG. Thyroid dysfunction in nonvalvular atrial fibrillation and clinical outcomes. Endocrine. 2024;86(1):239-45.
Shah R, Orlov S, Paré G, Gerstein HC. Thyroid Dysfunction and Cardiovascular Events in Patients With Dysglycemia. Can J Diabetes. 2023;47(3):257-62.
Papadopoulou AM, Bakogiannis N, Skrapari I, Moris D, Bakoyiannis C. Thyroid Dysfunction and Atherosclerosis: A Systematic Review. In Vivo. 2020;34(6):3127-36.
Kumar Singh N, Suri A, Kumari M, Kaushik P. A study on serum homocysteine and oxidized LDL as markers of cardiovascular risk in patients with overt hypothyroidism. Horm Mol Biol Clin Investig. 2022;43(3):329-35.
Saric MS, Jurasic MJ, Budincevic H, Milosevic M, Kranjcec B, Kovacic S, et al. The role of thyroid hormones in carotid arterial wall remodeling in women. Rom J Intern Med. 2022;60(1):24-33.
Yu OHY, Filliter C, Filion KB, Platt RW, Grad R, Renoux C. Levothyroxine Treatment of Subclinical Hypothyroidism and the Risk of Adverse Cardiovascular Events. Thyroid. 2024;34(10):1214-24.
Park H, Cho SW, Lee SH, Kim K, Kang HS, Kim JE, et al. Is Thyroid Dysfunction Associated with Unruptured Intracranial Aneurysms? A Population-Based, Nested Case-Control Study from Korea. Thyroid. 2023;33(12):1483-90.
Patrizio A, Ferrari SM, Elia G, Ragusa F, Balestri E, Botrini C, et al. Hypothyroidism and metabolic cardiovascular disease. Front Endocrinol (Lausanne). 2024;15:1408684.
Rajkarnikar S, Sharma VK, Baidya S, Kadel P, Tuladhar ET, Niraula A, et al. High Sensitive C-Reactive Protein and Lipid Profile Alteration In Subclinical Hypothyroidism for Cardiovascular Risk Assessment. J Nepal Health Res Counc. 2024;22(2):306-10.
Zhang S, Yu H, Zhao Y, Gong A, Guan C, Chen S, et al. Genetically predicted hypothyroidism, thyroid hormone treatment, and the risk of cardiovascular diseases: a mendelian randomization study. BMC Cardiovasc Disord. 2024;24(1):479.
Tunç Karaman S, Polat AO, Basat O. Evaluating cardiac electrophysiological markers for predicting arrhythmic risk in hypothyroid patients. Postgrad Med. 2024;136(8):833-40.
Elbaz BA, Elmarsafawy HM, Laimon WN. The effect of cardiac catheterization on thyroid functions in infants with congenital heart diseases: a prospective observational study. Eur J Pediatr. 2025;184(2):137.
Mao G, Chen M, Huang L, Mo Z, Su D, Gu S, et al. Differences in Vitamin A Levels and Their Association with the Atherogenic Index of Plasma and Subclinical Hypothyroidism in Adults: A Cross-Sectional Analysis in China. Nutrients. 2024;16(16).
Evron JM, Papaleontiou M. Decision Making in Subclinical Thyroid Disease. Med Clin North Am. 2021;105(6):1033-45.
Cai L, Wang P, Xue C, Chen J, Zhang Y. Clinical Characteristics and Risk Factors Associated With Adverse Pregnancy Outcomes in Patients With Gestational Hypothyroidism: A Case-Control Study. Endocr Pract. 2024;30(2):101-6.
Lin Y, Guo R, Cao S, Gao G, Zeng Y. Causal role of thyroid function in functional outcome after ischemic stroke: A Mendelian randomization study. J Stroke Cerebrovasc Dis. 2024;33(12):108019.
Birck MG, Janovsky C, Goulart AC, Meneghini V, Pititto BA, Sgarbi JA, et al. Associations of TSH, free T3, free T4, and conversion ratio with incident hypertension: results from the prospective Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Arch Endocrinol Metab. 2024;68:e230301.
Su X, Liu Y, Li G, Liu X, Huang S, Duan T, et al. Associations of Hypothyroxinemia With Risk of Preeclampsia-Eclampsia and Gestational Hypertension. Front Endocrinol (Lausanne). 2021;12:777152.
Fang X, Hu R, Fei S, Ding Z, Zhao J, Shang J. Associations between cardiovascular health and low thyroid function among US adults: a population-based study. Front Endocrinol (Lausanne). 2024;15:1437386.
Kravchenko M, Forbes W, Graybill S. Association of Serum Thyroxine and Atrial Fibrillation in Patients on Levothyroxine. Mil Med. 2025;190(1-2):e221-e7.
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Copyright (c) 2025 Shabahat Arain, Saad Umer Thanvi , Naheed Shah, Muhammad Damil Farid, Ali Raza, Irfan Ishaque, Salih Noor, Syed Muhammad Afraz Haider (Author)
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