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Impaired Endothelium-Dependent Vasodilatation in Subclinical Hypothyroidism: Beneficial Effect of Levothyroxine Therapy
Abstract
Subclinical hypothyroidism (sHT) is associated with enhanced cardiovascular risk. To test the hypothesis that patients with sHT are characterized by endothelial dysfunction and impaired nitric oxide (NO) availability, in 14 patients [serum cholesterol, 218 +/- 41 mg/dl (5.6 +/- 0.9 mM)] and 28 euthyroid subjects, subdivided into groups A and B [serum cholesterol, 170 +/- 19 mg/dl (4.4 +/- 0.5 mM) and 217 +/- 21 mg/dl (5.6 +/- 0.5 mM), respectively], we studied the forearm blood flow (strain-gauge plethysmography) response to intrabrachial acetylcholine, an endothelium-dependent vasodilator, at baseline and during infusion of N(G)-monomethyl-L-arginine (L-NMMA), a NO synthase inhibitor. Response to sodium nitroprusside and minimal forearm vascular resistances were also evaluated. In sHT patients, vasodilation to acetylcholine was reduced, compared with group B (+358 +/- 29% vs. +503 +/- 19%, P = 0.0003) and group A (663 +/- 65%, P = 0.02 vs. group B and P = 0.0002 vs. sHT). L-NMMA blunted the vasodilation to acetylcholine in groups A and B (49.1 +/- 6.3% and 42.7 +/- 5.5% maximal forearm blood flow reduction, respectively, P < 0.0001 vs. acetylcholine), whereas it was ineffective in sHT patients (12.8 +/- 2.5%). Response to sodium nitroprusside and minimal vascular resistances were similar. In sHT (n = 9) patients, 6 months of euthyroidism by levothyroxine replacement increased acetylcholine-vasodilation and restored L-NMMA inhibition. Patients with sHT are characterized by endothelial dysfunction resulting from a reduction in NO availability, an alteration partially independent of dyslipidemia and reversed by levothyroxine supplementation.
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“Both hyperlipidemia and thyroid antibodies are thought to reduce expression of endothelial nitric oxide synthase, thereby impairing vasodilation (15).”
From Thyroid Hormones and Cardiovascular Function and Diseases (2018) · cites this paper as [15]
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Metadata
- Authors
- Taddei, S., Caraccio, N., Virdis, A., Dardano, A., Versari, D., Ghiadoni, L., Salvetti, A., Ferrannini, E., & Monzani, F.
- Affiliations
- University of Pisa (IT)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2003-08-01
- Volume
- 88
- Issue
- 8
- Pages
- 3731-3737
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2060930755
- Cited by
- 431
- References
- 43
- Citations by year
- 2026: 8 · 2025: 6 · 2024: 14 · 2023: 15 · 2022: 24 · 2021: 14 · 2020: 27 · 2019: 19 · 2018: 19 · 2017: 12 · 2016: 24 · 2015: 17 · 2014: 34 · 2013: 26 · 2012: 26
- FWCI
- 9.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Keywords
- subclinical hypothyroidism, endothelial dysfunction, endothelium-dependent vasodilation, nitric oxide bioavailability, levothyroxine, acetylcholine, L-NMMA, forearm blood flow, dyslipidemia, cardiovascular risk, sodium nitroprusside
- MeSH terms
- Acetylcholine, Adult, Endothelium, Vascular, Enzyme Inhibitors, Female, Humans, Hypothyroidism, Iodide Peroxidase, Lipids, Lipoproteins, LDL, Male, Nitric Oxide, Nitroprusside, Regional Blood Flow, Thyroglobulin, Thyroid Hormones, Thyroiditis, Autoimmune, Thyroxine, Vascular Resistance, Vasodilation, Vasodilator Agents, Nitric Oxide Synthase, omega-N-Methylarginine, Nitric Oxide Donors, Nitric Oxide Synthase Type III
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