Thyroid hormones and cardiovascular disease

Jabbar, Avais; Pingitore, Alessandro; Pearce, Simon H. S.; Zaman, Azfar; Iervasi, Giorgio; Razvi, Salman

doi:10.1038/nrcardio.2016.174

Cited by 729Thyroid Disorders and TreatmentsHormonal and reproductive studiesThyroid and Parathyroid Surgery

Thyroid hormones and cardiovascular disease

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Jabbar, Avais, Pingitore, Alessandro, Pearce, Simon H. S., Zaman, Azfar, Iervasi, Giorgio, Razvi, Salman·2017·Nature Reviews Cardiology

DOI 10.1038/nrcardio.2016.174

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Abstract

Myocardial and vascular endothelial tissues have receptors for thyroid hormones and are sensitive to changes in the concentrations of circulating thyroid hormones. The importance of thyroid hormones in maintaining cardiovascular homeostasis can be deduced from clinical and experimental data showing that even subtle changes in thyroid hormone concentrations - such as those observed in subclinical hypothyroidism or hyperthyroidism, and low triiodothyronine syndrome - adversely influence the cardiovascular system. Some potential mechanisms linking the two conditions are dyslipidaemia, endothelial dysfunction, blood pressure changes, and direct effects of thyroid hormones on the myocardium. Several interventional trials showed that treatment of subclinical thyroid diseases improves cardiovascular risk factors, which implies potential benefits for reducing cardiovascular events. Over the past 2 decades, accumulating evidence supports the association between abnormal thyroid function at the time of an acute myocardial infarction (MI) and subsequent adverse cardiovascular outcomes. Furthermore, experimental studies showed that thyroid hormones can have an important therapeutic role in reducing infarct size and improving myocardial function after acute MI. In this Review, we summarize the literature on thyroid function in cardiovascular diseases, both as a risk factor as well as in the setting of cardiovascular diseases such as heart failure or acute MI, and outline the effect of thyroid hormone replacement therapy for reducing the risk of cardiovascular disease.

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In heart failure, thyroid hormones have a cardioprotective role through direct or indirect actions on myocytes, interstitium, and vasculature.
“In the context of HF, THs have a cardioprotective role through multifaceted direct or indirect actions at the level of the myocytes, the interstitium, and the vasculature (Figure 2) (6).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [6]
Lower thyroid hormone levels in the heart during acute ischemia may still be detrimental because of thyroid hormone's role in postischemic left ventricular remodeling, maintaining cardiovascular function, and mitochondrial integrity.
“Although a reduction in oxygen consumption by lowering TH levels during acute ischemia could be considered beneficial, the net effect of lower TH levels in the heart may still be detrimental because of its important role in postischemic LV remodeling, maintaining CV function and mitochondrial integrity (6).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [6]
Patients with severe hyperthyroidism may have coronary vasospasm leading to chest pain at rest or myocardial ischemia.
“Patients with severe hyperthyroidism may have coronary vasospasm leading to chest pain at rest or myocardial ischemia(6,70,71,79).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [6]
Excess thyroid hormone increases cardiac output by affecting stroke volume and heart rate.
“excess increases cardiac output by affecting stroke volume and heart rate(6,71).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [6]

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2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A. M., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001193 · Cited by 2,989 · see citing works
2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure
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2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines
Heidenreich, P. A., Bozkurt, B., Aguilar, D., Allen, L. A., Byun, J. J., Colvin, M. M., Deswal, A., Drazner, M. H., Dunlay, S. M., Evers, L. R., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001063 · Cited by 4,922 · see citing works
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation
Joglar, J. A., Chung, M. K., Armbruster, A. L., Benjamin, E. J., Chyou, J. Y., Cronin, E. M., Deswal, A., Eckhardt, L. L., Goldberger, Z. D., Gopinathannair, R., et al. (2024) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2023.08.017 · Cited by 933 · see citing works
Thyroid Hormones and Cardiovascular Function and Diseases
Razvi, S., Jabbar, A., Pingitore, A., Danzi, S., Biondi, B., Klein, I., Peeters, R., Zaman, A., & Iervasi, G. (2018) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.02.045 · Cited by 515 · see citing works
Hypothyroidism and the Heart
Udovcic, M., Pena, R. H., Patham, B., Tabatabai, L. S., & Kansara, A. (2017) · Methodist DeBakey Cardiovascular Journal · doi:10.14797/mdcj-13-2-55 · Cited by 308 · see citing works
Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes
Kannan, L., Shaw, P. A., Morley, M. P., Brandimarto, J., Fang, J. C., Sweitzer, N. K., Cappola, T. P., & Cappola, A. R. (2018) · Circulation: Heart Failure · doi:10.1161/circheartfailure.118.005266 · Cited by 245 · see citing works
Cardiotoxicity with vascular endothelial growth factor inhibitor therapy
Touyz, R. M., & Herrmann, J. (2018) · npj Precision Oncology · doi:10.1038/s41698-018-0056-z · Cited by 203 · see citing works
The classic pathways of thyroid hormone metabolism
van der Spek, A. H., Fliers, E., & Boelen, A. (2017) · Molecular and Cellular Endocrinology · doi:10.1016/j.mce.2017.01.025 · Cited by 194 · see citing works
Circulating heart failure biomarkers beyond natriuretic peptides: review from the Biomarker Study Group of the Heart Failure Association ( HFA ), European Society of Cardiology ( ESC )
Meijers, W. C., Bayés‐Genís, A., Mebazaa, A., Bauersachs, J. K., Cleland, J. G. F., Coats, A. J. S., Januzzi, J. L., Maisel, A. S., McDonald, K., Mueller, T., et al. (2021) · European Journal of Heart Failure · doi:10.1002/ejhf.2346 · Cited by 194 · see citing works
Deiodinases control local cellular and systemic thyroid hormone availability
Köhrle, J., & Frädrich, C. (2022) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2022.09.024 · Cited by 133 · see citing works
Thyroid Hormone Plays an Important Role in Cardiac Function: From Bench to Bedside
Yamakawa, H., Kato, T., Noh, J. Y., Yuasa, S., Kawamura, A., Fukuda, K., & Aizawa, Y. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2021.606931 · Cited by 137 · see citing works
Thyroid and Cardiovascular Disease
Cappola, A. R., Desai, A. S., Medici, M., Cooper, L. S., Egan, D., Sopko, G. S., Fishman, G. I., Goldman, S., Cooper, D. S., Mora, S., et al. (2019) · Circulation · doi:10.1161/circulationaha.118.036859 · Cited by 132 · see citing works
Thyroid disorders and cardiovascular manifestations: an update
Paschou, S. Α., Bletsa, E., Stampouloglou, P. K., Tsigkou, V., Valatsou, A., Stefanaki, K., Kazakou, P., Spartalis, Μ., Spartalis, E. D., Oikonomou, E. K., et al. (2022) · Endocrine · doi:10.1007/s12020-022-02982-4 · Cited by 132 · see citing works
Hyperthyroidism, Hypothyroidism, and Cause-Specific Mortality in a Large Cohort of Women
Journy, N., Bernier, M., Doody, M. M., Alexander, B. H., Linet, M. S., & Kitahara, C. M. (2017) · Thyroid · doi:10.1089/thy.2017.0063 · Cited by 119 · see citing works
Hyperthyroidism
Chaker, L., Cooper, D. S., Walsh, J. P., & Peeters, R. P. (2024) · The Lancet · doi:10.1016/s0140-6736(23)02016-0 · Cited by 129 · see citing works
Hypothyroidism in the older population
Leng, O., & Razvi, S. (2019) · Thyroid Research · doi:10.1186/s13044-019-0063-3 · Cited by 112 · see citing works
Duration of Hyperthyroidism and Lack of Sufficient Treatment Are Associated with Increased Cardiovascular Risk
Lillevang‐Johansen, M., Abrahamsen, B., Jørgensen, H. L., Brix, T. H., & Hegedűs, L. D. (2019) · Thyroid · doi:10.1089/thy.2018.0320 · Cited by 101 · see citing works
Thyroid and Cardiovascular Disease: Research Agenda for Enhancing Knowledge, Prevention, and Treatment
Cappola, A. R., Desai, A. S., Medici, M., Cooper, L. S., Egan, D., Sopko, G. S., Fishman, G. I., Goldman, S., Cooper, D. S., Mora, S., et al. (2019) · Thyroid · doi:10.1089/thy.2018.0416 · Cited by 95 · see citing works
Selenium, Selenoproteins, and Heart Failure: Current Knowledge and Future Perspective
Al‐Mubarak, A. A., van der Meer, P., & Bömer, N. (2021) · Current Heart Failure Reports · doi:10.1007/s11897-021-00511-4 · Cited by 89 · see citing works
FT3/FT4 ratio is correlated with all-cause mortality, cardiovascular mortality, and cardiovascular disease risk: NHANES 2007-2012
Lang, X., Li, Y., Zhang, D., Zhang, Y., Wu, N., & Zhang, Y. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.964822 · Cited by 84 · see citing works
The impact of thyroid hormone dysfunction on ischemic heart disease
von Hafe, M., Neves, J. S., Vale, C., Borges‐Canha, M., & Leite-Moreira, A. F. (2019) · Endocrine Connections · doi:10.1530/ec-19-0096 · Cited by 83 · see citing works
The Role of Thyroid Hormones in Heart Failure
Vale, C., Neves, J. S., von Hafe, M., Borges‐Canha, M., & Leite-Moreira, A. F. (2019) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-019-06870-4 · Cited by 78 · see citing works
Improving translational research in sex-specific effects of comorbidities and risk factors in ischaemic heart disease and cardioprotection: position paper and recommendations of the ESC Working Group on Cellular Biology of the Heart
Perrino, C., Ferdinandy, P., Bøtker, H. E., Brundel, B. J. J. M., Collins, P. D., Davidson, S. M., den Ruijter, H. M., Engel, F. B., Gerdts, E., Girão, H., et al. (2020) · Cardiovascular Research · doi:10.1093/cvr/cvaa155 · Cited by 84 · see citing works
Disruption by stealth - Interference of endocrine disrupting chemicals on hormonal crosstalk with thyroid axis function in humans and other animals
Thambirajah, A. A., Wade, M. G., Jonathan Verreault, A., Buisine, N., Alves, V. A., Langlois, V. S., & Helbing, C. C. (2021) · Environmental Research · doi:10.1016/j.envres.2021.111906 · Cited by 76 · see citing works
Hormesis in Health and Chronic Diseases
Li, X., Yang, T., & Sun, Z. (2019) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2019.08.007 · Cited by 72 · see citing works
Levothyroxine for the Treatment of Subclinical Hypothyroidism and Cardiovascular Disease
Sue, L. Y., & Leung, A. M. (2020) · Frontiers in Endocrinology · doi:10.3389/fendo.2020.591588 · Cited by 76 · see citing works
Initial evaluation of thyroid dysfunction - Are simultaneous TSH and fT4 tests necessary?
Schneider, C., Feller, M., Bauer, D. C., Collet, T., da Costa, B. R., Auer, R., Peeters, R. P., Brown, S. J., Bremner, A., O'Leary, P. C., et al. (2018) · PLoS ONE · doi:10.1371/journal.pone.0196631 · Cited by 72 · see citing works
Effect of Levothyroxine on Left Ventricular Ejection Fraction in Patients With Subclinical Hypothyroidism and Acute Myocardial Infarction: A Randomized Clinical Trial
Jabbar, A., Ingoe, L., Junejo, S., Carey, P., Addison, C., Thomas, H., Parikh, J. D., Austin, D., Hollingsworth, K. G., Stocken, D. D., et al. (2020) · JAMA · doi:10.1001/jama.2020.9389 · Cited by 64 · see citing works
Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies
Kalra, S., Aggarwal, S., & Khandelwal, D. (2021) · International Journal of Endocrinology · doi:10.1155/2021/9641846 · Cited by 66 · see citing works
The optimal healthy ranges of thyroid function defined by the risk of cardiovascular disease and mortality: systematic review and individual participant data meta-analysis
Xu, Y., Derakhshan, A., Hysaj, O., Wildisen, L., Ittermann, T., Pingitore, A., Abolhassani, N., Medici, M., Kiemeney, L. A. L. M., Riksen, N. P., et al. (2023) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(23)00227-9 · Cited by 61 · see citing works
Self-citation
Intrathyroidal feedforward and feedback network regulating thyroid hormone synthesis and secretion
Jing, L., & Zhang, Q. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.992883 · Cited by 61 · see citing works
Usefulness of Triiodothyronine Replacement Therapy in Patients With ST Elevation Myocardial Infarction and Borderline/Reduced Triiodothyronine Levels (from the THIRST Study)
Pingitore, A., Mastorci, F., Piaggi, P., Aquaro, G. D., Molinaro, S., Ravani, M., Caterina, A. D., Trianni, G., Ndreu, R., Berti, S. L., et al. (2018) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2018.12.020 · Cited by 61 · see citing works
The Association of Overt and Subclinical Hyperthyroidism with the Risk of Cardiovascular Events and Cardiovascular Mortality: Meta-Analysis and Systematic Review of Cohort Studies
Sohn, S. Y., Lee, E., Lee, M. K., & Lee, J. H. (2020) · Endocrinology and Metabolism · doi:10.3803/enm.2020.728 · Cited by 60 · see citing works
State of Knowledge on Molecular Adaptations to Exercise in Humans: Historical Perspectives and Future Directions
Lavin, K. M., Coen, P. M., Baptista, L. C. P., Bell, M. B., Drummer, D. J., Harper, S. A., Lixandrão, M. E., McAdam, J. S., O’Bryan, S. M., Ramos, S. V., et al. (2022) · Comprehensive physiology · doi:10.1002/cphy.c200033 · Cited by 74 · see citing works
Gut microbiota metabolites as integral mediators in cardiovascular diseases (Review)
Zhu, Y., Shui, X., Liang, Z., Huang, Z., Qi, Y., He, Y., Chen, C., Luo, H., & Lei, W. (2020) · International Journal of Molecular Medicine · doi:10.3892/ijmm.2020.4674 · Cited by 60 · see citing works
Ultrasensitive quantitative detection of small molecules with rapid lateral-flow assay based on high-affinity bifunctional ligand and magnetic nanolabels
Znoyko, S. L., Орлов, А. В., Pushkarev, A. V., Mochalova, E. N., Guteneva, N. V., Lunin, A. V., Nikitin, M. P., & Nikitin, P. I. (2018) · Analytica Chimica Acta · doi:10.1016/j.aca.2018.07.012 · Cited by 58 · see citing works
Stage-dependent cardiac regeneration in Xenopus is regulated by thyroid hormone availability
Marshall, L., Vivien, C. J., Girardot, F., Péricard, L., Scerbo, P., Palmier, K., DEMENEIX, B. A., & Coen, L. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1803794116 · Cited by 57 · see citing works
Angiopoietin 2 signal complexity in cardiovascular disease and cancer
Nicolini, G., Forini, F., Kusmic, C., Iervasi, G., & Balzan, S. (2019) · Life Sciences · doi:10.1016/j.lfs.2019.117080 · Cited by 57 · see citing works
2026 ESC Guidelines for the management of heart failure
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Thyroid Hormones and Cardiovascular Function and Diseases
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Authors: Jabbar, A., Pingitore, A., Pearce, S. H. S., Zaman, A., Iervasi, G., & Razvi, S.
Affiliations: Freeman Hospital (GB)
Istituto di Fisiologia Clinica (IT)
Royal Victoria Infirmary (GB)
Gateshead Health NHS Foundation Trust (GB)
Corresponding author: Razvi, Salman
ORCID: Pingitore, Alessandro
Pearce, Simon H. S.
Zaman, Azfar
Iervasi, Giorgio
Razvi, Salman
Venue: Nature Reviews Cardiology
Publisher: Springer Science and Business Media LLC
Published: 2016-11-04
Volume: 14
Issue: 1
Pages: 39-55
ISSN: 1759-5002 (ISSN-L)
1759-5010
DOI: 10.1038/nrcardio.2016.174
OpenAlex: W2548036931
Cited by: 729
References: 253
Citations by year: 2026: 65 · 2025: 78 · 2024: 89 · 2023: 95 · 2022: 107 · 2021: 87 · 2020: 88 · 2019: 47 · 2018: 42 · 2017: 25 · 2014: 1 · 2012: 1
FWCI: 5.53
Type: journal article
Language: en
Open access: green
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Nature Reviews Cardiology (publishedVersion)
PubMed (publishedVersion)
Newcastle University ePrints (Newcastle Univesity)
Funders: National Institute for Health and Care Research (PB-PG-0610-22139, CDF-2012-05-231)
Medical Research Council (G0500783)
NIHR Academy
Topics: Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords: thyroid hormones, cardiovascular disease, heart failure, acute myocardial infarction, subclinical hypothyroidism, hyperthyroidism, low triiodothyronine syndrome, thyroid hormone receptor, endothelial dysfunction, dyslipidemia, blood pressure, thyroid hormone replacement, cardiovascular risk factors, infarct size
MeSH terms: Cardiovascular Diseases, Cardiovascular System, Humans, Hyperthyroidism, Hypothyroidism, Thyroid Hormones, Hormone Replacement Therapy

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