Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-23T08:32:18.508Z Has data issue: false hasContentIssue false

Follow-up of congenital heart disease patients with subclinical hypothyroidism

Published online by Cambridge University Press:  23 September 2014

Efrén Martínez-Quintana*
Affiliation:
Cardiology Service, Complejo Hospitalario Universitario Insular-Materno InfantilLas Palmas de Gran Canaria, Spain
Fayna Rodríguez-González
Affiliation:
Dr Negrín University Hospital of Gran Canaria, Las Palmas de Gran Canaria, Spain
*
Correspondence to: E. Martínez Quintana, MD, PhD, Cardiology Service, Complejo Universitario Insular-Materno Infantil, Avenida Marítima del Sur s/n. 35016, Las Palmas de Gran Canaria, Spain. Tel: +0034 928441360; Fax: +0034 928441853; E-mail: [email protected]

Abstract

Introduction: Subclinical hypothyroidism or mild thyroid failure is a common problem in patients without known thyroid disease. Methods: Demographic and analytical data were collected in 309, of which 181 were male and 128 were female, congenital heart disease (CHD) patients. CHD patients with thyroid-stimulating hormone above 5.5 mIU/L were also followed up from an analytical point of view to determine changes in serum glucose, cholesterol, N-terminal pro b-type natriuretic peptide, and C-reactive protein concentrations. Results: Of the CHD patients, 35 (11.3%) showed thyroid-stimulating hormone concentration above 5.5 mIU/L. Of them, 27 were followed up during 2.4±1.2 years – 10 were under thyroid hormone replacement treatment, and 17 were not. Of the 27 patients (25.9%), 7 with subclinical hypothyroidism had positive anti-thyroid peroxidase, and 3 of them (42.8%) with positive anti-thyroid peroxidase had Down syndrome. Down syndrome and hypoxaemic CHD patients showed higher thyroid-stimulating hormone concentrations than the rest of the congenital patients (p<0.001). No significant differences were observed in serum thyroxine, creatinine, uric acid, lipids, C-reactive protein, or N-terminal pro b-type natriuretic peptide concentrations before and after the follow-up in those CHD patients with thyroid-stimulating hormone above 5.5 mIU/L whether or not they received levothyroxine therapy. Conclusions: CHD patients with subclinical hypothyroidism showed no significant changes in serum thyroxine, cholesterol, C-reactive protein, or N-terminal pro b-type natriuretic peptide concentrations whether or not they were treated with thyroid hormone replacement therapy.

Type
Original Articles
Copyright
© Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Klee, GG, Hay, ID. Biochemical testing of thyroid function. Endocrinol Metab Clin North Am 1997; 26: 763775.Google Scholar
2. Meyerovitch, J, Rotman-Pikielny, P, Sherf, M, et al. Serum thyrotropin measurements in the community: five-year follow-up in a large network of primary care physicians. Arch Intern Med 2007; 167: 15331538.CrossRefGoogle Scholar
3. Hollowell, JG, Staehling, NW, Flanders, WD, et al. Serum TSH, T4 and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 2002; 87: 489499.Google Scholar
4. Martínez-Quintana, E, Rodríguez-González, F, Nieto-Lago, V. Subclinical hypothyroidism in grown-up congenital heart disease patients. Pediatr Cardiol 2013; 34: 912917.CrossRefGoogle ScholarPubMed
5. Quiñones, MA, Otto, CM, Stoddard, M, et al. Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002; 15: 167184.Google Scholar
6. Karmisholt, J, Andersen, S, Laurberg, P. Variation in thyroid function in subclinical hypothyroidism: importance of clinical follow-up and therapy. Eur J Endocrinol 2011; 164: 317323.CrossRefGoogle ScholarPubMed
7. Curnock, AL, Dweik, RA, Higgins, BH, Saadi, HF, Arroliga, AC. High prevalence of hypothyroidism in patients with primary pulmonary hypertension. Am J Med Sci 1999; 318: 289292.Google Scholar
8. Bogaard, HJ, Al Husseini, A, Farkas, L, Farkas, D, Gomez-Arroyo, J, Abbate, A, Voelkel, NF. Severe pulmonary hypertension: the role of metabolic and endocrine disorders. Pulm Circ 2012; 2: 148154.Google Scholar
9. Franklyn, JA. The thyroid – too much and too little across the ages. The consequences of subclinical thyroid dysfunction. Clin Endocrinol (Oxf) 2013; 78: 18.CrossRefGoogle ScholarPubMed
10. Selikowitz, M. A five-year longitudinal study of thyroid function in children with Down syndrome. Dev Med Child Neurol 1993; 35: 396401.CrossRefGoogle ScholarPubMed
11. Martino, E, Bartalena, L, Bogazzi, F, et al. The effects of amiodarone on the thyroid. Endoc Rev 2001; 22: 240254.Google ScholarPubMed
12. Vanderpump, MP, Tunbridge, WM, French, JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf) 1995; 43: 5568.Google Scholar
13. Tuzcu, A, Bahceci, M, Gokalp, D, et al. Subclinical hypothyroidism may be associated with elevated high-sensitive c-reactive protein (low grade inflammation) and fasting hyperinsulinemia. Endocr J 2005; 52: 8994.Google Scholar
14. Hueston, WJ, King, DE, Geesey, ME. Serum biomarkers for cardiovascular inflammation in subclinical hypothyroidism. Clin Endocrinol 2005; 63: 582587.CrossRefGoogle ScholarPubMed
15. Moshang, T Jr, Chance, KH, Kaplan, M, et al. Effects of hypoxia on thyroid function tests. J Pediatr 1980; 97: 602604.Google Scholar
16. Martínez-Quintana, E, Rodríguez-González, F, Nieto-Lago, V, et al. Serum glucose and lipid levels in adult congenital heart disease patients. Metabolism 2010; 59: 16421648.CrossRefGoogle ScholarPubMed
17. Ineck, BA, Ng, TM. Effects of subclinical hypothyroidism and its treatment on serum lipids. Ann Pharmacother 2003; 37: 725730.Google Scholar
18. Hueston, WJ, Pearson, WS. Subclinical hypothyroidism and the risk of hypercholesterolemia. Ann Fam Med 2004; 2: 351355.Google Scholar
19. Danese, MD, Ladenson, PW, Meinert, CL, et al. Effect of thyroxine therapy on serum lipoproteins in patients with mild thyroid failure: a quantitative review of the literature. J Clin Endocrinol Metab 2000; 85: 29933001.Google Scholar
20. Meier, C, Staub, JJ, Roth, CB, et al. TSH-controlled l-thyroxine therapy reduces cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double blind, placebo-controlled trial (Basel Thyroid Study). J Clin Endocrinol Metab 2001; 86: 48604866.Google Scholar
21. Surks, MI, Ortiz, E, Daniels, GH, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management. JAMA 2004; 291: 228238.Google Scholar
22. Pearce, EN. Update in lipid alterations in subclinical hypothyroidism. J Clin Endocrinol Metab 2012; 97: 326333.Google Scholar
23. Bilic-komarica, E, Beciragic, A, Junuzovic, D. Effects of treatment with l-thyroxin on glucose regulation in patients with subclinical hypothyroidism. Med Arch 2012; 66: 364368.Google Scholar
24. Rhee, CM, Curhan, GC, Alexander, EK, et al. Subclinical hypothyroidism and survival: the effects of heart failure and race. J Clin Endocrinol Metab 2013; 98: 23262336.CrossRefGoogle ScholarPubMed