Does subclinical hypothyroidism affect cardiac pump performance?
Open accessAbstract
Objectives We sought to assess the effects of subclinical hypothyroidism (SHT) on the cardiac volumes and function.Background The cardiovascular system is one of the principal targets of thyroid hormones. Subclinical hypothyroidism is a common disorder that may represent "early" thyroid failure.Methods Thyroid profile was evaluated in 30 females with SHT and 20 matched control subjects. Left ventricular end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), cardiac index (CI), and systemic vascular resistance (SVR) were calculated by cardiac magnetic resonance (CMR). Regional greatest systolic lengthening (E1) and greatest systolic shortening (E2) were calculated by tagging CMR.Results EDV was lower in SHT than in controls (64.3 +/- 8.7 ml/m(2) vs. 81.4 +/- 11.3 ml/m(2), p < 0.001), as well as SV [corrected] (38.9 +/- 7.5 ml/m(2) vs. 52.5 +/- 6.1 ml/m(2), p < 0.001) and CI (2.6 +/- 0.5 l/[min.m(2)] vs. 3.7 +/- 0.4 l/[min.m(2)], p < 0.001). SVR [corrected] was higher in SHT (12.5 +/- 2.5 mm Hg.min/[l.m(2)] vs. 8.6 +/- 1.1 mm Hg.min/[l.m(2)], p = 0.003). The E1 was higher in controls than in SHT at the basal (p = 0.007), equatorial (p = 0.05), and apical (p = 0.008) levels, as well as E2 at the equatorial (p = 0.001) and apical (p = 0.001) levels. All parameters normalized after replacement therapy. A negative correlation between TSH and EDV (p < 0.001), SV (p < 0.001), CI (p < 0.001), and E1 at the apical level (p < 0.001) and a positive correlation between TSH and SVR (p < 0.001) and E2 at the apical level (p < 0.001) were found.Conclusions Subclinical hypothyroidism significantly decreased cardiac preload, whereas it increased afterload with a consequent reduction in SV and cardiac output. Replacement therapy fully normalized the hemodynamic alterations.
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Trials of levothyroxine in subclinical hypothyroidism using surrogate markers have shown improvement in left ventricular function, vascular endothelial function, atherogenic lipid particles, or cardiac mitochondrial function.
“Trials of levothyroxine in SCH using surrogate markers have shown improvement in LV function, vascular endothelial function, atherogenic lipid particles, or cardiac mitochondrial function (4,91,105-108).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [108]
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References 35 · Cited by 157
Research works printed but not linked: 1
- [16]16. hypothyroidism in patients with overt primary thyroid failure: cross sectional survey. BMJ 2003;326:311-2.
- Authors
- Ripoli, A., Pingitore, A., Favilli, B., Bottoni, A., Turchi, S., Osman, N. F., De Marchi, D., Lombardi, M., L'Abbate, A., & Iervasi, G.
- Affiliations
- Istituto di Fisiologia Clinica (IT)
- Johns Hopkins University (US)
- Corresponding author
- Pingitore, Alessandro
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2005-02
- Volume
- 45
- Issue
- 3
- Pages
- 439-445
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2152277743
- Cited by
- 157
- References
- 35
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 6 · 2023: 8 · 2022: 3 · 2021: 5 · 2020: 15 · 2019: 8 · 2018: 11 · 2017: 7 · 2016: 4 · 2015: 7 · 2014: 7 · 2013: 12 · 2012: 5
- FWCI
- 6.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutional Research Information System (Sant'Anna School of Advanced Studies) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- subclinical hypothyroidism, cardiac function, left ventricular volume, stroke volume, cardiac index, systemic vascular resistance, thyroid-stimulating hormone, thyroid hormone replacement, women, left ventricular ejection fraction, left ventricular mass, left atrial volume, left ventricular hypertrophy
- MeSH terms
- Adult, Female, Heart Ventricles, Humans, Hypothyroidism, Middle Aged, Stroke Volume, Thyroid Hormones, Vascular Resistance, Case-Control Studies, Magnetic Resonance Imaging, Cine, Hormone Replacement Therapy
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