Abstract
Thyroid dysfunction, either thyrotoxicosis or hypothyroidism, represents an important cardiovascular risk factor. Heart disease is the leading cause of death for men and women in the United States. Cardiovascular disease is multifactorial and many efforts have been made to assess precipitants for optimal guideline-based, primary, and secondary prevention. Thyroid hormone receptors are present in the myocardium and endothelium, and small alterations in its levels could have significant effects in cardiac function. Specifically, overt hypothyroidism is associated with an increased risk for atherosclerotic cardiovascular disease due to metabolic and hemodynamic effects. Several concomitant factors like impaired lipid profile, low-grade chronic inflammatory state, increased oxidative stress and increased insulin resistance enforce this relationship. The last decade has seen a renewed interest on the impact of subclinical hypothyroidism on the cardiovascular system and whether or not it should be treated. The aim of this review is to provide current evidence of the effect of thyroid hormone replacement, either with levothyroxine mono-therapy or in combination with liothyronine, on specific cardiovascular parameters.
Highlights
Hypothyroidism presents in a wide biochemical and clinical spectrum from Subclinical (SH) to Overt Hypothyroidism (OH) and myxedema coma
We focused on the effect of thyroid hormone replacement on cardiovascular
Literature search was performed in English through PUBMED, querying for key words: hypothyroidism, thyroid hormone treatment, L-T4, L-T3, heart failure, blood pressure, hypertension, carotid intima-media thickness, and hyperlipidemia
Summary
Hypothyroidism presents in a wide biochemical and clinical spectrum from Subclinical (SH) to Overt Hypothyroidism (OH) and myxedema coma. Hypothyroidism is the most common endocrine disorder after diabetes and standard treatment with Levothyroxine (LT4) replacement is established as monotherapy, multiple symptoms remain unresolved despite maintaining a normal TSH. This led over the last two decades to several trials with combination treatment [Levothyroxine (L-T4)/Liothyronine (L-T3)] [1]. Typical signs and symptoms of hypothyroidism are correlated with the severity and duration of the disease, but are associated with patient’s age, sex, other comorbidities, and the etiology of hypothyroidism. Assessment of the signs and symptoms could be challenging especially if alterations in the thyroid hormone levels are subtle
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