A study of association between serum TSH levels and severity of heart failure in subclinical hypothyroidism

Authors

  • Sudha K. Department of Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Prabhu S. Department of Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India
  • Naazim J. Khan Department of Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India https://orcid.org/0000-0003-0113-2753
  • Ramesh N. Teli Department of Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230179

Keywords:

Subclinical hypothyroidism, Heart failure, Thyroid stimulating harmone

Abstract

Background: Cardiovascular diseases account for most common cause of death in India and world so far. One of the established risk factors for HF is subclinical hypothyroidism. Our study aimed to study the relationship between TSH levels in subclinical hypothyroidism and the clinical severity of HF in patients with pre-existing HF.

Methods: This cross-sectional study was conducted in the hospitals attached to Bangalore medical college and research Institute. 51 patients with HF who had subclinical hypothyroidism who satisfied the inclusion criteria were included, Data was collected in the form of history, clinical examination and relevant investigations. Statistical analysis was performed using SPSS software, p<0.05 was considered significant.

Results: Out of 51 patients, 70.6% were males and 29.4% were females and majority of the patients (33.3%) were aged 40 to 50 years. 35.3% patients had LV global hypokinesia, 31.4% had LV diastolic dysfunction and 21.6% had RWMA. Chi-square test showed statistically significant association between TSH and RWMA(p=0.00). Out of the 51 patients, NYHA Class-1 were 9.8%, Class-2 were 31.4%, Class-3 were 27.5% and Class-4 were 31.4%. Chi-square test showed no statistically significant association between TSH levels and NYHA class (p=0. 32).

Conclusions: There was significant association between features suggestive of cardiac compromise on 2D-echocardiography with subclinical hypothyroidism, but there was no significant association between the severity of HF assessed clinically by NYHA class with subclinical hypothyroidism. Hence, our study couldn’t establish an association between severity of subclinical hypothyroidism on clinical severity of existing HF.

References

Kahaly GJ, Kampmann C M-KS. Cardiovascular hemodynamics and exercise tolerance in thyroid disease. Thyroid. 2002;12(6):473-81.

IM Sowers JR G. Thyroid and the heart. Am J Med. 2014;127:691-8.

Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. American association of clinical endocrinologists and american thyroid association taskforce on hypothyroidism in adults. Am Assoc Clin Endocrinol Thyroid. 2012;22(12):1200-35.

Leese GP, Flynn RV, Jung RT, Macdonald TM, Murphy MJ MA. Increasing prevalence and incidence of thyroid disease in tayside, scotland: the thyroid epidemiology audit and research study (TEARS). Clin Endocrinol. 2008;68:311-6.

Biondi B, Palmieri EA, Lombardi G FS. Effects of subclinical thyroid dysfunction on the heart. Ann Intern Med.2002;137:904-14.

Nicolas R, Bauer DC, Cappola AR, Cornuz J, Robbins JLPF. Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure. J Am Coll Cardiol. 2008;52:14.

Surks MI, Ortiz EDG. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA. 2004;291:228-38.

M. H. Screening for subclinical thyroid dysfunction in nonpregnant adults:a summary of the evidence for the U.S. Preventive Services Task Force. Ann Inter Med. 2004;140:128-41.

Fetourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc. 2009; 84(1):65-71.

Khatawkar A, Awati S. Thyroid gland historical aspects, embryology, anatomy and physiology. Int Arch Intern Med. 2015;2(9):165-71.

Niazi A, Irfan A, Kalra S, Islam A.Thyroidology over the ages. Indian J Endocrinol Metab. 2011;15(6):121-6.

Koenig RJ, Rosen CJ, Auchus RJ, Goldfine AB. Williams Textbook of Endocrinology. Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. 14th ed. Philadelphia; Elsevier Health Sciences: 2020; 332-3.

Mann DL. Braunwald’s heart disease e-book: A textbook of cardiovascular medicine. 11th ed. Elsevier Health Sciences; 2011:495.

Piers LS, Soares MJ, McCormack LMOK. Is there evidence for an age-related reduction in metabolic rate? J Appl Physiol. 1998;85:2196-204.

Kuchulakanti PK, Bandaru VCSS, Kuchulakanti A, Lakshumaiah T, Rathod M, Sairam P, et al. Association of subclinical hypothyroidism in heart failure: a study from South India. Br J Cardiol. 2019; 26(1):1-5.

Zhang J, Huang C, Meng Z, Fan Y, Yang Q, Zhang W, et al. Gender-specific differences on the association of hypertension with subclinical thyroid dysfunction. 2019.

Efstathiadou Z, Bitsis S, Milionis HJ, Kukuvitis A, Bairaktari ET, Elisaf MS, et al. Lipid profile in subclinical hypothyroidism: Is L-thyroxine substitution beneficial Eur J Endocrinol. 2001;145(6): 705-10.

Rodondi N, Bauer DC, Cappola AR, Cornuz J, Robbins J, Fried LP, et al. Subclinical thyroid dysfunction, cardiac function, and the risk of heart failure. the cardiovascular health study. J Am Coll Cardiol. 2008;52(14):1152-9.

Biondi B, Palmieri E, Fazio S, Cosco C, Nocera M, Sacca L, et al. Endogenous subclinical hyperthyroidism effects quality of life and cardiac morphology and function in young and middle-aged patients. J Clin Endocrinol Metab. 2000;85:4701-5.

Razvi S, Weaver JU, Butler TJ. Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality. Arch Intern Med. 2012;172:811-7.

Villar HC, Saconato H, Valente O. Thyroid hormone replacement for subclinical hypothyroidism. Cochrane Database Syst Rev. 2007;3:419.

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Published

2023-01-25

How to Cite

K., S., S., P., J. Khan, N., & N. Teli, R. (2023). A study of association between serum TSH levels and severity of heart failure in subclinical hypothyroidism. International Journal of Research in Medical Sciences, 11(2), 647–653. https://doi.org/10.18203/2320-6012.ijrms20230179

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Original Research Articles