Association of subclinical hypothyroidism with atherosclerosis in central India

Vibhor Upadhyay, K. Deopujari, T.N. Dubey, A. Sharma, Pooja Tripathi


Introduction: Overt hypothyroidism is widely recognized as a risk factor for atherosclerosis and cardiovascular disease, but recently subclinical hypothyroidism has also shownas an independent risk for it. Subclinical hypothyroidism also has close association withdyslipidemia and lowgrade inflammation leading to atherosclerosis which can be assessed by carotid intimal medial thickness. Objective: The objective of the study was to explore the correlation of subclinical hypothyroidism with atherosclerosis in the form of dyslipidemia, C Reactive Protein and Carotid Intimal Medial Thickness in patients of central India. Methods: This study was conducted at department of medicine in GMC, Bhopal. It was a case control study among which 100 patientswith raised TSH and normal T3/T4 values were included as cases in the study and 50 controls with normal TSH/T3/T4 were taken.Three groups were made according to TSH values as euthyroids (<5.5), Subclinical Hypothyroids group 1(5.5-10) & group 2 (>10) and their fasting lipid profile, CReactive Protein levels and Carotid Intimal Medial Thicknesswere measured. Results: We compared the Subclinical Hypothyroids with euthyroids subjects in whichlipid profile was highly significant (<0.01) and showed positive correlation in both groups of Subclinical Hypothyroids except for high density lipoprotein.In cases where TSH (>5.5) the CRP was found to be significantly associated showing presence of low grade inflammation in these patients. The study also showed that mean Carotid Intimal Medial Thickness was higher in Subclinical group as compared to euthyroids but only when TSH(>10). Conclusion: This study concludes that subclinical hypothyroidism is characterized by dyslipidemiawith increased Carotid medial intimal thickness value and positive CReactive Proteinsuggesting the future development of cardiovascular disease in these patients.

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Cappola AR, Ladenson et al PW 2003 Hypo-thyroidism and atherosclerosis. J ClinEndocrinol Metab 88:2438–2444.

Canaris GJ, Manowitz NR et al EC 2000 The Colorado Thyroid Disease Prevalence Study. ArchIntern Med 160: 526-534.

Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, Braverman LE. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002 Feb; 87(2):489-99.DOI: 10.1210/jcem. 87.2.8182

Bastenie PA, Vanhaelst L et al 1967 Coronary artery disease in hypothyroidism:observation in preclinical myxoedema. Lancet 2:1221.

Neves C, Alves M et al, 2008 Thyroiddiseases, dyslipidemia and cardiovascular pathology.Rev Port Cardiol 27: 1211-1236.

Papi G, Uberti ED, Betterle C, Carani C, Pearce EN, Braverman LE, Roti E: Subclinical hypo-thyroidism. Curr Opin Endocrinol Diabetes Obes 2007;14:197 –208.

Neves C, Alves M et al, 2008 Thyroiddiseases, dyslipidemia and cardiovascular pathology.Rev Port Cardiol 27: 1211-1236.

Fowler PBS, Swale J et al970 Hyper-cholesterolaemia in border line hypo-thyroidism: stage of premyxoedema. Lancet 2:488–491.

Hansson GK; Inflammation, atherosclerosis, and coronary artery disease. N. Engl. J. Med,2005;352: 1685–1695.

de Groot E, Hovingh GK et al. Measurement ofde Groot E, Hovingh GK et al. Measurement ofarterial wall thickness as a surrogate marker for atherosclerosis.Circulation. 2004;109:II33­8.

Burtis CA, Ashwood ER, Bruns DE. Teitz fundamentals of clinical chemistry. Saunders An imprint ofElsevier Inc., Pennsylvania, 2010, pp. 422-424.

Duntas LH; Thyroid disease and lipids. Thyroid, 2002;12:287-293.

Asvold BO, Vatten L et al. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study, Eur J Endocrinol, 2007;156: 181-186.

Cooper DS, Halpern R et al. Thyroxine therapy in subclinical hypothyroidism. A double-blind placebo-controlled trial. Ann Intern Med 1984; 101:18–24.

Tanis BC, Westendorp GJ, Smelt HM. Effect of thyroid substitution on hypercholesterolaemia in patients with subclinical hypothyroidism: A reanalysis of intervention studies. Clin Endocrinol (Oxf) 1996;44:643-9.

Celik C, Abali R, Tasdemir N, Guzel S, Yuksel A, Aksu E et al.Is subclinical hypothyroidism contributing dyslipidemia and insulin resistance in women with polycystic ovary syndrome, Gynecol Endocrinol 2012; 28(8):615-618.

Luboshitzky R, Aviv A, Herer P, Lavie L, Risk factors for cardiovascular disease in women with subclinical hypothyroidism, Thyroid 2002; 12(5): 421-425.

Boekholdt SM, Titan SM, Wiersinga WM, etal. Initial thyroid status and cardiovascularrisk factors: the EPIC-Norfolk prospective population study. Clin Endocrinol (Oxf) 2010; 72: 404–410.

Monzani F, Caraccio N, Kozàkowà M, Dardano A, Vittone F, Virdis A, et al. Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypo-thyroidism: A double-blind, placebo- controlled study. J Clin Endocrinol Metab. 2004;89:2099–2106.

Nagasaki T, Inaba M et al, 2003 Decrease in carotid intima-media thickness in hypothyroid patients after normalization of thyroid function Clin Endocrinol (Oxf) 59:607–612.

Kim SK, Kim SH, Park KS, Park SW, Cho YW. Regression of the increased common carotid artery-intima media thickness in subclinical hypothyroidism after thyroid hormone replacement. Endocr J.2009;56:753–758.

Chiche F, Jublanc C, Coudert M, Carreau V, Kahn JF, Bruckert E. Hypothyroidism is not associated with increased carotid atherosclerosis when cardiovascular risk factors are accounted for in hyperlipidemic patients. Atherosclerosis. 2009; 203:269–276.

Kvetny J, Heldgaard PE et al, 2004Subclinical hypothyroidism is associated with a low grade in flammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years.Clin Endocrinol (Oxf) 61: 232-238.

Christ-Crain M, Meier C et al. Elevated C-reactive protein and homocysteine values: cardiovascular risk factor in hypothyroidism? A cross-sectional and double-blind, placebo-controlled trial. Atherosclerosis, 2003;166:379-386.

Tuzcu A, Bahceci M et al; Subclinical hypothyroidism may be associated with elevated high-sensitive Creactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J, 2005; 52: 89–94.

Tian L, Gao C, Liu J, Zhang X. Increased carotid arterial stiffness in subclinical hypo-thyroidism. Eur J Intern Med. 2010;21:560–563.

Senthil kumaran S, Sathyaprakash V, Sundhararajan A. Study on Prevalence and Distribution of Subclinical Hypothyroidism in Rural Women, Sch J App Med Sci 2015; 3(1D): 287-290.

Karthick N, Dillara K, Poornima KN, Subhasini AS. Dyslipidaemic Changes in Women with Subclinical Hypothyroidism, J Clin Diagn Res 2013; 7(10):2122-2125.

LeGrys VA, Funk MJ, Lorenz CE, et al.Subclinical hypothyroidism and risk for incident myocardial infarction among postmenopausal women, J Clin Endocrinol Metab 2013; 98(6): 2308-2317.


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