Prospective echocardiographic evaluation of patients with endogenous subclinical hyperthyroidism and after restoring euthyroidism: Subclinical hyperthyroidism and the heart
Abstract
OBJECTIVES: Clinical significance of, and the need for, treatment in subclinical hyperthyroidism (sHT) is still a matter of debate. The aim of the study was to assess the impact of sHT on echocardiographic parameters. DESIGN: Patients with endogenous sHT of nonautoimmune origin underwent full echocardiographic assessment at diagnosis and after restoring euthyroidism with radioiodine treatment. PATIENTS: Studied group consisted of 44 patients (37 women, 7 men), aged 22-65 years (mean 45·9±11·0). MEASUREMENTS: Full echocardiographic assessment included estimation of cardiac chamber diameters and volume as well as cardiac contractility, according to the guidelines of the American Society of Echocardiography. Left ventricular mass was calculated according to Penn's convention. For estimation of left ventricle diastolic function, the following echocardiographic parameters were obtained: maximal early filling wave velocity (E), maximal late filling wave velocity (A), E/A ratio, isovolumetric relaxation time and early filling wave deceleration time. RESULTS: In the studied group, phase of sHT was associated with increased volume of heart chambers, increased diameter of ascending aorta, increased left ventricle mass and disturbed left ventricle relaxation (P<0·05). The systolic function of the left ventricle was unaffected; however, the ejection time was shortened. The changes were reversible with restoring biochemical euthyroidism (P<0·05). Moreover, a significant correlation between some of the parameters and thyroid hormones concentration was demonstrated. CONCLUSIONS: sHT was associated with significant changes in echocardiographic parameters, which may contribute to increased cardiovascular risk in these patients. The alterations were reversible with restoring biochemical euthyroidism, what supports the necessity of treatment introduction in sHT.
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A prospective study showed a significant improvement of cardiovascular parameters after treatment of hyperthyroidism.
“A prospective study showed a significant improvement of cardiovascular parameters after treatment of hyperthyroidism [67] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [67]
Some studies suggest that cardioselective β-blockers or treatment of SHyper with ATDs may improve symptoms, heart rate and supraventricular arrhythmias in patients with grade 2 SHyper.
“Some studies suggest that cardioselective β-blockers [47,48] or treatment of SHyper with ATDs [46,67] may improve symptoms, heart rate and supraventricular arrhythmias in patients with grade 2 SHyper.”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [67]
In young adults with undetectable serum TSH levels, subclinical hyperthyroidism may increase left ventricular mass, arterial stiffness, and left atrial size, and may induce diastolic dysfunction and impair left ventricular performance.
“In young adults with undetectable serum TSH levels, SHyper may increase left ventricular mass, arterial stiffness and left atrial size, and may induce diastolic dysfunction and impair left ventricular performance [45,46,67] .”
From The 2015 European Thyroid Association Guidelines on Diagnosis and Treatment of Endogenous Subclinical Hyperthyroidism (2015) · cites this paper as [67]
The evidence rests only with small uncontrolled studies that have shown improvements in cardiac structure and function, heart rate and the frequency of premature atrial and ventricular beats, bone mineral density, and muscle strength.
“Thus, the evidence rests only with small uncontrolled studies that have shown improvements in cardiac structure and function, heart rate and the frequency of premature atrial and ventricular beats, bone mineral density, and muscle strength (393)(394)(395)(396)405,(414)(415)(416)(417)426).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [396]
Mechanistic correlates of these findings include increased left ventricular mass and impaired left ventricular function in SH that improve with treatment.
“Mechanistic correlates of these findings include increased left ventricular mass and impaired left ventricular function in SH that improve with treatment (393-396).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [396]
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References 34 · Cited by 45
- Authors
- Kaminski, G., Michalkiewicz, D., Makowski, K., Podgajny, Z., Szalus, N., Ruchala, M., Szczepanek, E., & Gielerak, G.
- Affiliations
- Poznan University of Medical Sciences (PL)
- ORCID
- Gielerak, Grzegorz
- Venue
- Clinical Endocrinology
- Publisher
- Wiley
- Published
- 2011-03-07
- Volume
- 74
- Issue
- 4
- Pages
- 501-507
- ISSN
- 0300-0664 (ISSN-L)
- OpenAlex
- W1564323473
- Cited by
- 45
- References
- 34
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 5 · 2014: 2 · 2013: 3 · 2012: 4
- FWCI
- 2.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- 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 › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- subclinical hyperthyroidism, radioiodine therapy, left ventricular mass, left ventricular diastolic function, left ventricular relaxation, left ventricular systolic function, cardiovascular risk, thyroid hormones, echocardiographic parameters
- MeSH terms
- Adult, Aged, Echocardiography, Female, Humans, Hyperthyroidism, Iodine Radioisotopes, Male, Middle Aged, Prospective Studies, Thyroid Gland, Thyrotropin, Thyroxine, Young Adult
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