Influence Of Subclinical Hypothyroidism Research Articles

Subclinical Hypothyroidism Predicted Adverse Cardiovascular Events in Patients with Ejection Fraction Preserved Heart Failure.

Subclinical hypothyroidism (SH) increases the risk of cardiovascular events, however the influence of SH on prognosis of ejection fraction preserved heart failure (HFpEF) is not fully understood. In this prospective observational study, patients with HFpEF were divided into euthyroidism group (n = 413) and SH group (n = 79). Patients were followed up for at least 30 months to examine the association between SH and cardiovascular events in patients with HFpEF. The primary end point was composite cardiovascular events (cardiovascular death and re-hospitalization). The patients underwent flow-mediated dilation (FMD) measurement by ultrasound in order to value endothelial function. The rate of composite cardiovascular events was higher in SH group than in euthyroidism group (54.49% and 26.36%, respectively; p < 0.001). The higher risk of cardiovascular events in SH group was primarily due to a higher risk of re-hospitalization compared to euthyroidism group (45.56% and 20.58%, respectively; p < 0.001). The rate of cardiovascular death was higher in SH group than in euthyroidism group (13.92% and 5.81%, respectively; p = 0.017). Cox proportional hazards regression showed that SH (hazard ratios [HR] 1.921, 95% confidence interval [CI] 1.139-3.240), level of TSH (HR 1.025, 95% CI 1.010-1.054), age (HR 1.017, 95% CI 1.002-1.034), LVEF (HR 0.975, 95% CI 0.953-0.996), atrial fibrillation (HR 1.581, 95% CI 1.083-2.307), eGFR (HR 0.987, 95% CI 0.978-0.997), and NYHA cardiac function (HR 2.342, 95% CI 1.649-3.326) were independent predictors of cardiovascular events in patients with HFpEF (all P < 0.05). Subclinical hypothyroidism was associated with increased cardiovascular events and death in patients with HFpEF.

Influence of subclinical hypothyroidism on cardiovascular disease risk in geriatric population: A cross-sectional study

Influence of subclinical hypothyroidism on cardiovascular disease risk in geriatric population: A cross-sectional study

Influence of Subclinical Hypothyroidism on Women With Polycystic Ovary Syndrome: A Literature Review.

Subclinical hypothyroidism (SCH) is a commonly encountered condition in women with polycystic ovary syndrome (PCOS). Nevertheless, it is unclear whether SCH has any potential impact on the metabolic and reproductive profiles of women with PCOS. Hence, this literature review explores and establishes the link between these two conditions. In women with PCOS, SCH was found to aggravate insulin resistance and dyslipidemia. It was also linked to hormonal imbalances leading to higher infertility rates among the PCOS-SCH group. Therefore, women with PCOS must be screened for thyroid function frequently and managed accordingly.

Influence of subclinical hypothyroidism on early outcome of patients undergoing CABG surgery

Influence of subclinical hypothyroidism on early outcome of patients undergoing CABG surgery

A Demographic Profile of ACS Associated with Thyroid Dysfunction in North Indian Population

Background: Thyroid disorders have an important bearing on the cardiovascular (CV) system leading to hypertension, dyslipidemia, heart rhythm disorders, obesity etc. Data regarding the influence of subclinical hypothyroidism and CV disease and outcomes have been conflicting. Since subclinical hypothyroidism is seen often in clinical syndromes of coronary artery disease, we undertook this study to evaluate the overall prevalence and demography of patients admitted with the diagnosis of ACS in a North Indian population.&#x0D; Methods: We studied consecutive 171 hospitalized patients between March 2018 to February 2020 with a diagnosis of acute coronary syndrome (ACS) to determine the features of thyroid dysfunction both clinical and sub-clinical and the associated biochemical parameters. All patients underwent complete medical history of cardiac risk factors for developing CAD. Thyroid function Tests - free T3, free T4 and TSH were collected from all the patients within 24 hours of admission to CCU.&#x0D; Results: Forty (23%) of these patients had thyroid dysfunction. Subclinical hypothyroidism was the commonest abnormality seen in 26 (23%), followed by overt hypothyroidism 12 (9%). Hyperthyroidism was uncommon (1.5%). Euthyroid sick syndrome was seen in 4% and these patients were excluded. &#x0D; There was a predilection for the elderly population (females 52%). STEMI (52%) followed by NSTEMI (25%) was the commonest diagnosis at presentation. A significant correlation was seen with serum lipid levels (decreased HDL C, Increased total cholesterol, triglycerides and VLDL C) and hypothyroidism. However, there was no correlation ship with LDL C.&#x0D; Reduced e glomerular filtration rate (e GFR) which was seen in 50% of patients had a linear relationship with hypothyroidism. Patients with hypothyroidism had no differences in the prevalence of concomitant diabetes and hypertension. The left ventricular ejection fraction (LVEF) in the group of patients had a trend to be lower.&#x0D; Conclusions: Hypothyroidism seems to be an important risk factor in patients with ACS, especially STEMI. The impairment of renal function was also prominent in these patients. These patients also suffered from impaired renal function.

Does Hashimoto's Thyroiditis Increase the Risk of Cardiovascular Disease in Young Type 1 Diabetic Patients?

Background: Immunological and hormonal disorders have undoubted influence on the development of atherosclerotic process. Autoimmune diseases accompanying type 1 diabetes (T1D) may additionally accelerate atherosclerosis progression and increase the risk of cardiovascular events in the future. The influence of subclinical hypothyroidism on the cardiovascular system, in particular, has recently aroused great interest. The aim of our study was to assess intima-media thickness (cIMT) of common carotid arteries and the occurrence of classical atherosclerosis risk factors together with selected new biomarkers of cardiovascular diseases in young patients with type 1 diabetes mellitus coexisting with Hashimoto's disease (HD).Patients and Methods: The study included 50 adolescents and young adults with T1D with mean age 17.1 ± 3 years, with mean diabetes duration of 10.5 ± 3.3 years, including 20 patients with diagnosed HD: T1D and HD(+), and 30 patients with no additional diseases: T1D and HD(–). Twenty-two healthy, age-matched volunteers formed control group (C). We analyzed mean HbA1c value from all years of disease, BMI, blood pressure, lipids, new biomarkers of atherosclerosis (hsCRP, adiponectin, myeloperoxidase, NT-proBNP peptide, vitamin D), and cIMT of common carotid arteries.Results: In the group of patients with T1D and HD(+), significantly higher BMI was found: 23.3 ± 4.4 vs. 21.28 ± 2.9 in group HD(–) and 19.65 ± 2.4 kg/m2 in group C (p = 0.003), and higher waist circumference: 79 ± 10.9 vs. 75.10 ± 7.6 in group HD(–) vs. 69.0 ± 7.4 cm in group C (p < 0.001). The mean value of HbA1c was higher in group T1D and HD(+): 8.8% than in group HD(–): 8.1% (p = 0.04). Significantly higher concentration of hsCRP and lower vitamin D were observed in T1D and HD(+) in comparison to T1D and HD(–) and the control group. The IMT index in the HD(+) group was 0.46 ± 0.05 mm and was comparable to the HD(–) group but significantly higher than in healthy controls: 0.41 ± 0.03 mm (P < 0.05).Conclusions: Young patients with type 1 diabetes mellitus and with coexisting Hashimoto's thyroiditis have a higher BMI, a higher waist circumference, and a higher HbA1c value, which altogether may cause faster development of macroangiopathy in the near future. Additional risk for cardiovascular disease may result from low vitamin D and increased hsCRP concentration in this group of patients. Coexistence of Hashimoto's thyroiditis did not significantly affect the cIMT value in the studied population.

Influence of subclinical hypothyroidism on metabolic parameters in obese children and adolescents.

BackgroundSubclinical hypothyroidism (SH) is a common condition in obese children. However, its effect on glucose and lipid metabolism in obese children remains controversial.PurposeThe present study aimed to investigate the association between SH and metabolic parameters.MethodsA total of 215 obese children and adolescents aged 6–18 years were included in this retrospective cross-sectional study. The patients’ anthropometric measurements such as thyrotropin (TSH), free thyroxine (fT4), fasting plasma glucose, and insulin levels, as well as homeostasis model assessment for insulin resistance (HOMA-IR) index, and lipid profiles were evaluated. The patients were allocated to the SH group (fT4 normal, TSH 5–10 mIU/L) (n=77) or the control group (fT4 normal, TSH<5 mIU/L) (n=138). The glucose and lipid metabolisms of the 2 groups were compared.ResultsSH was identified in 77 of 215 patients (36%). Mean body mass index was similar in both groups. The mean serum insulin, HOMA-IR, and triglyceride (TG) levels were higher and the mean high-density lipoprotein cholesterol level was lower in the SH group than in the control group (p=0.007, P=0.004, P=0.01, and P=0.02, respectively). A positive correlation was observed between TSH level and insulin level, HOMA-IR, and TG level.Conclusion SH was identified in some of the obese children and adolescents. A clear association was observed between SH, insulin resistance, and dyslipidemia in obese children.

Poremećaji kardiovaskularne funkcije i ehokardiografskih parametara srca u manifestnom i subkliničkom hipotireoidizmu

Decreased thyroid function leads to changes in cardiovascular hemodynamics, changes in myocardial contractility and accelerated atherosclerosis. Peripheral circulation in hypothyroidism is characterized by increased vascular resistance and prolonged circulatory duration. Endothelial dysfunction that occurs in hypothyroid patients predisposes to the development of atherosclerosis, and increases arterial stiffness. The influence of subclinical hypothyroidism on the cardiovascular system is manifested through systolic and diastolic cardiac function, myocardial anatomy and effort endurance. Subclinical hypothyroidism in acute myocardial infarction increases cardiac mortality 3.6-fold and 2.3-fold overall mortality. Overt hypothyroidism is characterized by hypercholesterolemia, significantly elevated LDL cholesterol and apolipoprotein B. Subclinical hypothyroidism is associated with a small increase in LDL cholesterol, a decrease in HDL cholesterol, increasing the risk of developing atherosclerosis and coronary artery disease. Isovolumic relaxation time (IVRT) is significantly prolonged in hypothyroid patients, which indicates impaired passive relaxation of the left ventricle. Global right ventricular strain and right ventricular free wall strain are reduced in hypothyroid patients compared to healthy subjects. These changes are completely reversible after the application of thyroid replacement therapy and mostly after 6 months of L-thyroxine administration.

Influence of subclinical hypothyroidism on indicators of 24-hour arterial blood pressure monitoring in hypertensive patients with high additional risk

Significant prevalence of arterial hypertension (40 % of the adult population) and unsatisfactory level of high blood pressure adequate control (only 14 % of the urban and 8 % of the rural population in Ukraine) underlines the need to study the factors influencing AH course and contributing to a lack of antihypertensive therapy efficacy. One of such factors is subclinical hypothyroidism (SH). Aim. To study Influence of subclinical hypothyroidism on indicators of 24-hour arterial blood pressure monitoring in hypertensive patients with high additional risk. Materials and methods. After signing of written informed consent for the study, 124 patients with arterial hypertension (AH) and 16 practically healthy people (control group) were involved. The main group included 32 AH patients (women 87.5 % (n = 28), men 12.5 % (n = 4)) with moderately elevated thyroid stimulating hormone level (TSH) (4.0–15.6 μD/ml) and normal levels of thyroid hormones. The comparison group consisted of 92 AH patients (women 81.52 % (n = 75), men 18.48 % (n = 17)) with normal levels of TSH (0.4–4.0 μD/ml). The groups of patients were matched for age (54.16 ± 10.16) years versus (57.69 ± 9.76) years, (P = 0.093), sex (P = 0.4319), height (P = 0.993), weight (P = 0.719), body surface area (P = 0.901), body mass index (P = 0.669). All patients underwent a combined 24-hour blood pressure monitoring and ECG using a “Cardiology-04-AD-3” device (St. Petersburg, RF). Results. AH patients with or without concomitant SH were of comparable mean daytime and nighttime indices of SBP and DPB, indicators of SBP and DBP variability, PBP, indices for hypertension and hypotension, circadian indices, indices of percentage SBP and DBP increases, SBP and DBP load (with the exception of daytime SBP load). Patients with AH and SH, in contrast to AH patients without SH, tended to have 8.5 % (P < 0.05) higher indices of daytime SBP load, and 19.3 % (P < 0.05) lower daytime DBP hypotension index. Conclusions . AH patients with or without concomitant SH are comparable by the vast majority of ABPM indicators. However, in AH patients with concomitant SH, unlike those without SH, a larger daytime SBP load and a lower daytime DBP hypotension index were detected.

Peculiarities of cardiovascular remodeling in hypertensive patients at high additional risk with concomitant subclinical hypothyroidism

Arterial hypertension affects over 12 million people in Ukraine, which accounts for about 30 % of the adult population, and is a powerful independent risk factor for cardiovascular morbidity and mortality. Subclinical hypothyroidism (SH) is also an independent causative factor of the cardiovascular risk and is associated with the development of ischemic heart disease, myocardial infarction, chronic heart failure and increased mortality from cardiovascular diseases regardless of sex, age or pre-existing cardiac pathology. Therefore, there is a need to study the influence of subclinical hypothyroidism on the cardiovascular remodeling peculiarities in patients with arterial hypertension (AH). Material and methods. The study involved 124 patients with AH stage II divided into two groups. The group of patients with AH without SH included 92 patients (women 81.52 % (75), men 18.48 % (17)) and 32 patients (women 87.5 % (28), men 12.5 % (4)) represented the group with AH and concomitant SH. The groups of patients were comparable in age (P = 0.093), sex (P = 0.44319), height (P = 0.993), weight (P = 0.719), body surface area (P = 0.901), body mass index (P = 0.669). In all patients underwent arterial blood pressure measurement (OMRON 750 IT,Japan), echocardiography and ultrasound of carotid arteries using the original QIMT software on My Lab 50 (Esaote,Italy). Results. In patients with AH with the concomitant SH, in contrast to patients with AH without SH, a significant increase in indexes of the intima-media complex thickness of the right common carotid artery by 8.2% (P < 0.05) and the left common carotid artery by 7.9 % (P < 0.05) was observed. Changes of structural, geometrical and functional indexes of the heart in patients with AH and SH were significant increase in the left atrial size by 3.5 % (P < 0.05), end diastolic size by 3.0 % (P < 0.05) and end systolic size of the left ventricle by 2.3 % (P < 0.05), myocardial mass index by 11.1 % (P < 0.05), index Е/Е´ by 13.0 % (P < 0.05), gradient of transpulmonary flow by 6.6 % (P < 0.05) in comparison to patients with AH without SH. Conclusions. In patients with AH and concomitant SH in contrast to patients with AH without SH, an increase in thickness of the intima-media complex of both common carotid arteries with comparable diameters of vessels has been established, as well as increase in size of the left atrium, left ventricular myocardial mass index mainly due to the left ventricular dilation, Е/Е´ index and pressure gradient in the pulmonary artery suggesting an increase in the end diastolic pressure and the left ventricular diastolic dysfunction.

Influence of subclinical hypothyroidism on parameters of tear production in patients with hypertension

Influence of subclinical hypothyroidism on parameters of tear production in patients with hypertension

The influence of subclinical hypothyroidism on serum lipid profile, PCSK9 levels and CD36 expression on monocytes

BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9) is a serine protease and a secreted protein which increases cholesterol levels in plasma via inducing degradation of low-density lipoprotein receptor (LDLR). Cluster of differentiation 36 (CD36) is a member of a family of cell surface proteins in many cells. CD36 is known as fatty acid translocase (FAT) because it imports fatty acids inside cells and participate in triglyceride storage. It has been suggested that PCSK9 regulates CD36 in some tissues. MethodsData and serum levels of TSH, FT4, lipid profile and PCSK9 and the expression of CD36 on monocytes from 40 new untreated patients with subclinical hypothyroidism (SH) and 40 age- sex- and BMI-matched euthyroid controls were analyzed in a cross-sectional study. Then the relationships between these parameters were examined. ResultsPatients with SH had higher TSH, FT4, total cholesterol (TC) and triglyceride (TG) Low-density lipoprotein (LDL) and PCSK9 levels than controls. There were significant and positive correlations between serum TSH levels and lipid parameters except HDL-C. PCSK9 had a significant and negative correlation with FT4. No significant correlation could be found in relation to PCSK9 and CD36. ConclusionsPCSK9 inhibitors are used to reduce blood cholesterol levels as drugs. If it will be proven that PCSK9 can induce CD36 degradation, taking these drugs may have unwanted side effects. This study showed that serum PCSK9 and lipid profile levels increase in patients with subclinical hypothyroidism and there is no relationship between PCSK9 and CD36 in these patients.

Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age

Obese women are at high risk for polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SCH) has been associated with weight gain, insulin resistance and impaired fertility, which are also factors involved in PCOS. However, there is limited information regarding the influence of SCH on the presence of PCOS. In order to determine whether SCH increases the prevalence of PCOS, we performed a cross-sectional study in a cohort of reproductive-aged obese women. All subjects underwent anthropometric evaluation, laboratory tests and ultrasound examination. Diagnosis of PCOS was based on the Rotterdam criteria. A total of 534 obese women were included and 108 (20.2%) of them were diagnosed with SCH. Patients with SCH showed similar insulin resistance, comparable androgen levels, and higher triglycerides levels (1.7 vs. 1.5 mmol/L, p = .002) compared to those with normal thyroid status. The frequency of PCOS did not differ between the two groups (56.1% for normal thyroid function vs. 60.2% for subclinical hypothyroidism, p = .514). In logistic regression analysis, SCH was not an independent risk factor for PCOS after adjusting for confounding factors (OR = 0.984, 95% CI 0.581–1.667). For the first time, our results suggest that SCH does not increase the risk of PCOS in obese women of reproductive age.

Impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention

BackgroundSimilar to overt hypothyroidism, subclinical hypothyroidism (SCH) has been reported to increase the risk of cardiovascular disease. However, the influence of SCH on clinical outcomes following percutaneous coronary intervention (PCI) remains unclear. MethodsWe performed a prospective cohort study. SCH was defined as a thyroid-stimulating hormone (TSH) level ≥4.5mIU/l and a normal level of free thyroxine (FT4). A composite event was defined as the combination of cardiac death, non-fatal myocardial infarction (MI) and repeat revascularization. ResultsOf 936 patients, who were observed for 3.1years, 100 patients (10.7%) were diagnosed with SCH. Repeat revascularization, cardiac death and a composite event occurred more frequently in the SCH group than in the euthyroidism group, while the incidence of non-fatal MI was similar between the two groups. Multiple Cox regression analysis showed that SCH was associated with the risk of a composite event (hazard ratio, 1.52; 95% confidence interval, 1.04–2.22) after adjustment for age, sex, current smoking, ST-segment elevation MI, prior PCI, diabetes, hypertension, renal function, left ventricular ejection fraction, B-type natriuretic peptide, stent numbers, total stent length, stent types, obesity and lipid profiles. Serum TSH levels were also significantly associated with the risk of a composite event. SCH was not associated with repeat PCIs for de novo stenotic lesions but was associated with repeated PCIs for in-stent restenotic lesions. ConclusionsSCH negatively impacted clinical outcomes following PCIs. Therefore, patients with SCH should be carefully observed after undergoing a PCI.

Features of the influence of subclinical hypothyroidism on the cardiovascular system.

Features of the influence of subclinical hypothyroidism on the cardiovascular system.

Assessment of insulin like growth factor-1 and IGF binding protein-3 in healthy Indian girls from Delhi and their correlation with age, pubertal status, obesity and thyroid hormonal status.

Population specific data and influence of sub-clinical hypothyroidism on insulin like growth factor-1 (IGF-1) and its binding protein-3 (IGFBP-3) in Indian children is lacking. This study was undertaken to evaluate serum IGF-1 and IGFBP-3 and their correlation with age, gender, pubertal status and thyroid functions. A total of 840 apparently healthy school girls aged 6-18 years, were recruited for the study and underwent assessment of height, weight, body mass index, pubertal status and serum T3, T4, TSH, IGF-1, IGFBP-3 and IGF-1/IGFBP-3 molar ratio. The mean serum levels of IGF-1, IGFBP-3 levels and IGF-1/IGFBP-3 molar ratio were 381.8±240.5 ng/mL, 4.19±2.08 μg/mL and 40.5±37.2%, respectively. The serum IGF-1 and IGF-1/IGFBP-3 molar ratio increased significantly (p<0.0001) at 11 years followed by a steady yet non-significant rise till 16 years of age. A similar pattern was observed for IGFBP-3 showing a steep rise at 12 years and peaking at 16 years. Likewise, serum levels of IGF-1 and molar ratio of IGF-1/IGFBP-3 increased significantly with pubertal maturation from stage 1 to 3 and were higher in overweight girls compared to normal weight and obese girls. The growth factors were no different in girls with or without subclinical hypothyroidism. There was no significant impact of age on IGF-1 and IGFBP-3 in pre-pubertal girls. A sudden marked increase at 11 years followed by a gradual rise in growth factors till 16 years is indicative of pubertal initiation and maturation. Subclinical hypothyroidism did not influence growth factors in girls.

Is subclinical hypothyroidism associated with lower live birth rates in women who have experienced unexplained recurrent miscarriage?

Thyroid disorders have been associated with recurrent miscarriage. Little evidence is available on the influence of subclinical hypothyroidism on live birth rates. In this cohort study, women who had experienced miscarriage and subclinical hypothyroidism (defined as thyroid-stimulating hormone >97.5th percentile mU/l with a normal thyroxine level) were investigated; the control group included women who had experienced recurrent miscarriage and normal thyroid function. Multivariable logistic regression was used to investigate the association of subclinical hypothyroidism. Data were available for 848 women; 20 (2.4%) had subclinical hypothyroidism; 818 women (96%) had euthyroidism; and 10 (1.2%) had overt hypothyroidism. The live birth rate was 45% in women with subclinical hypothyroidism and 52% in euthyroid women (OR 0.69, 95% CI 0.28 to 1.71). The ongoing pregnancy rate was 65% versus 69% (OR 0.82, 95% CI 0.32 to 2.10) and the miscarriage rate was 35% versus 28% (OR 1.43, 95% CI 0.56 to 3.68), respectively. No differences were found when thyroid stimulating hormone 2.5 mU/l was used as cut-off level to define subclinical hypothyroidism. In women with unexplained miscarriage, no differences were found in live birth, ongoing pregnancy and miscarriage rates between women with subclinical hypothyroidism and euthyroid women.

Modifying influence of subclinical hypothyroidism on arterial hypertension: relationship to masked treatment failure, circadian blood pressure profile and target organs status

Aim. The study aimed to investigate the modifying influence of subclinical hypothyroidism (SH) on arterial hypertension (AH), the prevalence of masked uncontrolled hypertension, circadian blood pressure (BP) profile and cardiovascular disorders. Materials and methods. We investigated twenty-four hours BP monitoring data and cardiovascular parameters in 101 hypertensive patients with normal thyroid function ( n = 45) or SH ( n = 56). Then, we observed 44 patients with AH and SH within six months; 24 of them received levothyroxine. Results. Patients with AH and SH had higher risk of masked uncontrolled hypertension (for TSH ≥ 5 mU/L, OR 1.9 [1.11, 3.26], p = 0.016); increased pulse BP, daily BP variability, non-dippers rate as well as more marked myocardial hypertrophy, arterial dysfunction and microcirculation deterioration ( p < 0.05 for all parameters). Levothyroxine therapy reduced the incidence of masked uncontrolled hypertension, ambulatory BP value, non-dippers rate and intensified microcirculation ( p < 0.05 for all parameters). Conclusion. SH is a risk factor for masked failure of antihypertensive therapy. SH impairs the profile of ambulatory BP and target organs damages in patients with AH. These disorders can be partly corrected by the use of levothyroxine.

The influence of subclinical hypothyroidism on glucose levels

The influence of subclinical hypothyroidism on glucose levels

Cardiovascular Risk and Subclinical Hypothyroidism: Focus on Lipids and New Emerging Risk Factors. What Is the Evidence?

Controversy remains as to the risk of cardiovascular disease (CVD) associated with subclinical hypothyroidism (SCH), defined as an increased serum thyrotropin (TSH) concentration with normal free thyroxine and triiodothyronine levels. Substantial evidence indicates altered cholesterol and lipoprotein metabolism in SCH when serum TSH is above 10 mU/L. Observed abnormalities include elevated plasma levels of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C); the altered TC/high-density lipoprotein-cholesterol (HDL-C) and LDL-C/HDL-C ratios suggest a potential accelerated risk for CVD. The influence of SCH on lipids is directly proportional to the degree of TSH elevation and becomes more significant with the progression from SCH to overt disease, thereby accelerating any propensity to atherosclerosis. Although many clinicians may tend to ignore SCH with TSH levels <10, it is apparent that an enhanced CV risk could apply to these individuals, perhaps compounded by insulin resistance and amplified by the copresence of other risk factors such as endothelial dysfunction and elevated C-reactive protein.