Abstract
Thyroid hormones play an important role in regulating different metabolism functions and multiple organs' performance. Changes in the thyroid hormone axis can lead to profound effects on the stability of vital organs and systems, especially the cardiovascular system. Hypothyroidism is classified according to the clinical presentation as overt and subclinical. There is some evidence supporting the benefits of thyroxine hormone replacement for subclinical hypothyroidism on cardiovascular mortality outcomes. However, the clinical relevance of measuring and treating high thyroid-stimulating hormone (TSH) levels in newly diagnosed heart failure patients with preserved ejection fraction requires further study. In this report, we review the current evidence regarding the prognostic significance of subclinical hypothyroidism in heart failure patients with preserved ejection fraction.
Highlights
Thyroid hormones regulate different metabolism functions and multiple organs’ performance
If hypothyroidism is associated with increased mortality in heart failure and there is evidence suggesting that there is a benefit from replacing thyroid hormones, at what extent should we consider replacing them?
As the diagnosis relies on an elevated level of the levels of Rthyroid-stimulating hormone (TSH), identifying the upper limit of reference range is critical in defining subclinical hypothyroidism
Summary
Thyroid hormones regulate different metabolism functions and multiple organs’ performance. These nuclear receptors bind themselves to thyroid hormone responsive elements located in the promoter regions of specific genes In the heart, these types of receptors have been identified as TR alpha-1, TR alpha-2, TR beta-1, and TR beta-2 [5]. Heart failure can downregulate the signal of the thyroid hormones in the heart with a net effect of increase in overall mortality. If hypothyroidism is associated with increased mortality in heart failure and there is evidence suggesting that there is a benefit from replacing thyroid hormones, at what extent should we consider replacing them?. There was a direct association with congestive heart failure, the levels of thyroid-stimulating hormones (TSH) were more than 7 mIU/L to be statistically significant and the sample included only hospitalized patients [13]
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