Cited by 172Thyroid Disorders and TreatmentsBlood Pressure and Hypertension StudiesHormonal Regulation and Hypertension

The DOI matches its Crossref record; 40 of the 40 references it cites were found in a registry or an index; 8 of the 29 sources its claims cite were checked for support.

The Role of Thyroid Hormone in Blood Pressure Homeostasis: Evidence from Short-Term Hypothyroidism in Humans

Open access
Fommei, Enza, Iervasi, Giorgio·2002·The Journal of Clinical Endocrinology & Metabolism

Abstract

Arterial hypertension is known to be frequently associated with thyroid dysfunction, with a particularly high prevalence in chronic hypothyroidism. However, to our knowledge no comprehensive study addressed causal mechanisms possibly involved in this association. We here report the physiological relationships between blood pressure and neuro-humoral modifications induced by acute hypothyroidism in normotensive subjects. Twelve normotensive patients with previous total thyroidectomy were studied. Ambulatory 24-h blood pressure monitoring was performed, and free T3, free T4, TSH, PRA, aldosterone, cortisol, adrenaline, and noradrenaline were assayed 6 wk after oral l-T4 withdrawal (phase 1) and 2 months after resumption of treatment (phase 2). During the hypothyroid state (TSH, 68.1 ± 27.7 μIU/ml; mean ± sd), daytime arterial systolic levels slightly, but significantly, increased (125.5 ± 9.7 vs. 120.4 ± 10.8 mm Hg; P < 0.05), and daytime diastolic levels (84.6 ± 7.9 vs. 76.4 ± 6.8 mm Hg; P < 0.001), noradrenaline (2954 ± 1578 vs. 1574 ± 962 pmol/liter; P < 0.001), and adrenaline (228.4 ± 160 vs. 111.3 ± 46.1 pmol/liter; P < 0.05) also increased. PRA remained unchanged (0.49 ± 0.37 vs. 0.35 ± 0.21 ng/ml·h; P = NS), whereas both aldosterone (310.3 ± 151 vs. 156.9 ± 67.5 pmol/liter; P < 0.005) and cortisol (409.2 ± 239 vs. 250.9 ± 113 pmol/liter; P < 0.02) significantly increased. By using univariate logistic regression daytime arterial diastolic values, noradrenaline and aldosterone were found to be significantly related to the hypothyroid state (P < 0.02, P < 0.036, and P < 0.024, respectively). In conclusion, our data show that thyroid hormones participate in the control of systemic arterial blood pressure homeostasis in normotensive subjects. The observed sympathetic and adrenal activation in hypothyroidism, which is reversible with thyroid hormone treatment, may also contribute to the development of arterial hypertension in human hypothyroidism.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

In 12 normotensive patients after total thyroidectomy, short-term L-T4 withdrawal-induced hypothyroidism raised daytime systolic and diastolic blood pressure and increased noradrenaline, adrenaline, aldosterone, and cortisol, while PRA did not change. These changes reversed with L-T4 replacement, suggesting thyroid hormone contributes to blood pressure homeostasis and that sympatho-adrenal activation may contribute to hypothyroid hypertension.

Key findings

  • During hypothyroidism (TSH 68.1 ± 27.7 IU/ml), daytime systolic BP increased from 120.4 ± 10.8 to 125.5 ± 9.7 mm Hg (P < 0.05) and daytime diastolic BP increased from 76.4 ± 6.8 to 84.6 ± 7.9 mm Hg (P < 0.001); nighttime BP changes were not significant.
  • Noradrenaline rose from 1574 ± 977 to 2954 ± 1578 pmol/liter (P = 0.001), adrenaline from 111.3 ± 46.1 to 228.6 ± 159.6 pmol/liter (P = 0.05), aldosterone from 156.8 ± 67.4 to 310.3 ± 151.3 pmol/liter (P < 0.005), and cortisol from 251.0 ± 113 to 409.11 ± 239 pmol/liter (P < 0.02).
  • PRA remained unchanged (0.35 ± 0.21 vs. 0.49 ± 0.38 ng/ml·h; NS).
  • In univariate logistic regression, daytime diastolic BP, noradrenaline, and aldosterone were significantly related to the hypothyroid state (P < 0.02, P < 0.036, and P < 0.024, respectively). The paper also reports that BP increased into the hypertensive range in one third of patients when hypothyroidism was induced.

Methods

  • Twelve normotensive patients (9 women, 3 men; mean age 50.7 ± 8.4 yr) with previous total thyroidectomy and radioiodine ablation for stage I differentiated thyroid cancer were studied in two phases: 6 wk after L-T4 withdrawal (hypothyroid phase 1) and 2 months after resumption of oral L-T4 replacement (phase 2).
  • At both time points, 24-h ambulatory BP monitoring was performed with a SPACE-LABS 90207 device, and plasma free T3, free T4, TSH, PRA, aldosterone, cortisol, adrenaline, and noradrenaline were assayed.
  • Continuous variables were compared by paired t test or Wilcoxon test; relationships were assessed by linear regression and univariate logistic regression, with P < 0.05 considered significant.

Limitations

  • Stated: the authors caution that results from this unique short-term human model may not transfer directly to long-term thyroid function abnormalities.
  • Stated: changes in catecholamines, aldosterone, and cortisol are difficult to interpret per se because hypothyroidism may alter intravascular volume, hormone clearance, salt sensitivity, vasopressin, and atrial natriuretic peptide.
  • Evident from the text: the sample is small (n = 12) and highly selected (normotensive patients with treated thyroid cancer and no other disease or pharmacological treatment), and the study lacks a separate control group, so generalizability is limited.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1210/jcem.87.5.8464

Cites

40 of 40 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

8 of 29 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured

Show all 28 claims

  • Probably not a substantial claim. 3
  • It may state two separate claims as one. 7
  • The quote only partly states this claim. 1
10 of 10
  • The paper relies on this without support.

    There are no prior studies on normotensive subjects showing the effect of short-term thyroid hormone variation on both blood pressure and its regulatory mechanisms.

    “To our knowledge, there are no studies carried out on normotensive subjects showing the effect of a short-term variation in thyroid hormone levels on both blood pressure and some of its important regulatory mechanisms represented by renin, sympathetic, and adrenal systems.”
  • The paper relies on this without support.

    The short-term hypothyroid state induced by 6-week L-T4 withdrawal is a valid model for studying the physiological role of thyroid hormone in BP homeostasis.

    “We addressed this issue by the use of a unique clinical model encompassing a short-term variation from a state of acute hypothyroidism to one of restoration of normal thyroid function in normotensive patients.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Several abstract hormone values differ from Table 1

    Minor

    The abstract and Table 1 give different values for the hypothyroid-state adrenaline mean (228.4 versus 228.6), hypothyroid-state PRA SD (0.37 versus 0.38), and treated-state aldosterone mean (156.9 versus 156.8). These differences are not attributable to rounding the tabulated values to the abstract's printed precision.

  • Noradrenaline SD differs between abstract and Table 1

    Minor

    The abstract gives the treated-state noradrenaline SD as 962 pmol/liter, whereas Table 1 gives 977 pmol/liter for the same mean.

  • Daytime DBP logistic-regression P value differs from Table 3

    Minor

    The abstract reports P < 0.02 for daytime diastolic blood pressure, but Table 3 gives P = 0.0287. Both values indicate significance at 0.05, but the tabulated value does not meet the abstract's stated threshold.

3 of 3

Citations

Cites

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Show all 37 references

Research works printed but not linked: 1

  1. Klein, 1989, Thyroid hormone and high blood pressure. In: Laragh JH, Brenner BM, Kaplan NM, eds. Endocrine mechanisms in hypertension., New York: Raven Press; vol, 2, 61

Cited by

Sorted by citations

Items 101–171 of 171

Metadata

Authors
Fommei, E., & Iervasi, G.
Affiliations
University of Pisa (IT)
Venue
The Journal of Clinical Endocrinology & Metabolism
Published
2002-05-01
Volume
87
Issue
5
Pages
1996-2000
ISSN
  • 0021-972X (ISSN-L)
  • 1945-7197
OpenAlex
W2050166046
Cited by
172
References
37
Citations by year
2026: 1 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 8 · 2017: 8 · 2016: 9 · 2015: 16 · 2014: 11 · 2013: 9 · 2012: 7
FWCI
3.26
Type
journal article
Language
en
Open access
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 › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal Regulation and Hypertension
Keywords
thyroid hormones, hypothyroidism, blood pressure, hypertension, thyroidectomy, levothyroxine withdrawal, norepinephrine, epinephrine, aldosterone, cortisol, renin-angiotensin system, sympathetic nervous system, thyroid-stimulating hormone, ambulatory blood pressure monitoring, normotensive subjects, diastolic blood pressure
MeSH terms
Adrenal Glands, Adult, Aged, Aldosterone, Blood Pressure, Combined Modality Therapy, Cortisone, Female, Homeostasis, Humans, Hypothyroidism, Male, Middle Aged, Regression Analysis, Renin, Sympathetic Nervous System, Thyroid Hormones, Thyroid Neoplasms, Thyroidectomy

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