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Expert addresses relevant relationship between thyroid, CVD
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SAN FRANCISCO — The relationship between thyroid disease and cardiovascular disease has been established. During a symposium presentation here, Endocrine Today Editorial Board Member, Jeffrey R. Garber, MD, discussed this link and recommendations for treatment.
“Hyperthyroidism via the direct actions of excess thyroid hormone increases tissue thermogenesis, decreases systemic vascular resistance, activates the renin-angiotensin system, and increases heart rate, contractility and diastolic relaxation. This combination results in decreased after load, increased preload and cardiac output. Virtually the opposite occurs with hypothyroidism",” Garber, president of the American College of Endocrinology and associate professor of medicine at Harvard Medical School, said during a presentation.
Jeffrey R. Garber
The American Association of Clinical Endocrinologists and the American Thyroid Association updated the clinical practice recommendations for hypothyroidism in adults for the first time in a decade in December 2012.
Garber discussed the clinical guidelines for the diagnosis of subclinical hypothyroidism and how it relates to cardiovascular disease. According to Garber, “nonspecific symptoms don’t make the diagnosis and early treatment in the case of mild disease to prevent it from getting worse later is not compelling since many do not progress and some remit.”
Garber said that according to the guidelines, patients with primary hypothyroidism and TSH levels >10 mIU/L should be treated. Additionally, Garber said clinicians should individualize treatment for patients with TSH levels ranging from 4.5 mIU/L to 10 mIU/L.
“There is argument by some to lower the TSH levels to lower than 4 to 4.5 or 2.5 to 3. While some patients with TSH values between 2.5 and 4.5 have early thyroid failure and some surrogate markers of cardiac disease may improve after thyroid hormone treatment there are no studies indicating that actual cardiac outcomes improve as a result. Lowering the upper normal could lead to the treatment of many elderly patients without evidence of thyroid disease who more commonly have TSH levels between 2.5 and 4.5 than younger patients. Yet they are the ones most at risk from overtreatment with thyroid hormone, which occurs much more frequently than many physicians realize,” Garber said. – by Samantha Costa
For more information:
Joint symposium of the American Association of Clinical Endocrinologists and the American College of Cardiology: The Endocrine Heart. Presented at: American College of Cardiology Scientific Sessions; March 9-11, 2013; San Francisco.
Disclosure: Garber reports no relevant financial disclosures.