Abstract
Sub-clinical hypothyroidism (SCH) is common in heart failure (HF) and advanced renal failure (RF), but it is unclear whether there is a thyroid disease or a transient increase in TSH level. This is a retrospective study of hospitalized patients in medical departments. All patients with SCH and a TSH level up to less than 12 mIU/L were identified. Those who had at least one recurring admission within at least 6 months were included. A change in thyroid function during the last re-admission was determined and classified as an improvement, no change, or worsening of thyroid function. Overall, 126 cases of SCH met the inclusion criteria for re-admission. Analysis of the most recent hospitalization showed that in 100 (79.4%) patients thyroid function improved, in 15 (11.9%) patients thyroid function remained unchanged and only in 11 (8.7%) patients did thyroid function worsen. In most cases, worsening of hypothyroidism was determined by initiation of a low dose levothyroxine treatment. Of the 126 participants, 43 (34.1%) and 22 (17.5%) had a diagnosis of HF and RF (CKD stages 4 and 5), respectively. There was no association between HF or advanced RF and worsening of SCH. No association was found between worsening of hypothyroidism and gender, age, TSH, or creatinine levels in the first hospitalization. A borderline association between elevated CRP levels at first hospitalization and hypothyroidism worsening was found (p = 0.066). Mildly elevated TSH in hospitalized patients with HF and advanced RF is transient and most probably not related to thyroid disease and not associated with age or gender.
Highlights
Sub-clinical hypothyroidism (SCH) is common in heart failure (HF) and advanced renal failure (RF), but it is unclear whether there is a thyroid disease or a transient increase in thyroid-stimulating hormone (TSH) level
For all the reasons mentioned above, slightly increased TSH and FT4 levels are within the norm in patients hospitalized with heart or renal failure; it is impossible to know whether the occurrence is an isolated increase in TSH level without thyroid disease, or whether it is SCH
In order to examine the association between background diseases and gender, and worsening of SCH, we considered the cases with improved or unchanged TSH on re-admission as one group and compared them to patients who had worsening in hypothyroidism on re-admission
Summary
Sub-clinical hypothyroidism (SCH) is common in heart failure (HF) and advanced renal failure (RF), but it is unclear whether there is a thyroid disease or a transient increase in TSH level. This is a retrospective study of hospitalized patients in medical departments. Elevated TSH in hospitalized patients with HF and advanced RF is transient and most probably not related to thyroid disease and not associated with age or gender. SCH is common in various chronic diseases including heart failure and end-stage renal failure, but it is unclear whether there is a thyroid disease or an isolated increase in TSH level[18,19]. For all the reasons mentioned above, slightly increased TSH and FT4 levels are within the norm in patients hospitalized with heart or renal failure; it is impossible to know whether the occurrence is an isolated increase in TSH level without thyroid disease, or whether it is SCH
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