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Effects of Subclinical Thyroid Dysfunction on the Heart

Bernadette Biondi, MD; Emiliano A. Palmieri, MD; Gaetano Lombardi, MD; and Serafino Fazio, MD
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From the University of Naples Federico II School of Medicine, Naples, Italy.

Acknowledgments: The authors thank Jean Ann Gilder for editing the text.

Grant Support: In part by Grant of Ministero d'niversità e della Ricerca Scientifica e Tecnologica (co-financed project, year 2000) (no. MM6263471-005).

Requests for Single Reprints: Bernadette Biondi, MD, Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II School of Medicine, via S. Pansini 5, 80131 Naples, Italy; e-mail, bebiondi@libero.it.

Current Author Addresses: Drs. Biondi and Lombardi: Department of Clinical and Molecular Endocrinology and Oncology, University of Naples Federico II School of Medicine, 80131 Naples, Italy.

Drs. Palmieri and Fazio: Department of Clinical Medicine and Cardiovascular Sciences, University of Naples Federico II School of Medicine, 80131 Naples, Italy.

Ann Intern Med. 2002;137(11):904-914. doi:10.7326/0003-4819-137-11-200212030-00011
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Background: Mounting evidence indicates that subclinical thyroid dysfunction has important clinical effects and prognostic implications, supporting the view that it is not a compensated biochemical change sensu strictu.

Purpose: To review clinical information on the effects of subclinical thyroid dysfunction on the heart.

Data Sources: English-language articles identified from files and a MEDLINE search (1970–September 2001), references of relevant articles, textbooks, and meeting abstracts.

Study Selection: Reports on the effects of subclinical hypothyroidism and subclinical hyperthyroidism on the cardiovascular system in humans.

Data Extraction: Data on cardiac structure and performance, arrhythmias, and risk for coronary artery disease were independently assessed by all authors and summarized.

Data Synthesis: Subclinical hypothyroidism is associated with impaired left ventricular diastolic function at rest, systolic dysfunction on effort, and enhanced risk for atherosclerosis and myocardial infarction. Subclinical hyperthyroidism is associated with increased heart rate, atrial arrhythmias, increased left ventricular mass with marginal concentric remodeling, impaired ventricular relaxation, reduced exercise performance, and increased risk for cardiovascular death. All abnormalities were reversed by restoration of euthyroidism (subclinical hypothyroidism) or were blunted by β-blockade and tailoring of the L-thyroxine dose (subclinical hyperthyroidism).

Conclusion: The heart responds to the minimal but persistent changes in circulating thyroid hormone levels typical of subclinical thyroid dysfunction. Thus, the condition is not a compensated biochemical change sensu strictu, and timely treatment should be considered in an attempt to avoid adverse cardiovascular effects.





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