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Thyroid hormone levels could signal risk for various adverse outcomes
Researchers in the United Kingdom have suggested that data on the screening and management of subclinical thyroid disease are lacking due to limited trials. They wrote that it remains unclear whether modest variations above or below the upper limit of normal have an impact on outcomes to justify intervention.
Variations among patients with thyroid function in the normal range are linked to adverse health outcomes, according to Peter N. Taylor, MRCP, a Welsh clinical academic trainee in diabetes and endocrinology with the Thyroid Research Group, Institute of Molecular and Experimental Medicine, and School of Medicine at Cardiff University, and colleagues.
“The continuum of effects across the reference range of thyroid function suggest that it might be more appropriate to consider thyroid hormone levels as ‘risk factors’ for disease (similar to blood pressure or cholesterol in cardiovascular disease), rather than consider a particular level to be ‘normal’ or ‘abnormal,’” the researchers wrote. “In this way of thinking, the net benefit of intervention at a particular TSH level can be related to an individual’s comorbidities.”
Peter N. Taylor
To challenge the available data, Taylor and colleagues pooled data from MEDLINE and the Cochrane Database of Systematic Reviews and Controlled Trials Register for articles which mentioned the effects of thyroid hormone parameters on CV, bone, metabolic, pregnancy, neurological and psychological outcomes. Forty papers were used in the study.
According to data, elevated TSH or lower thyroid hormone levels were associated with more CV risk factors and events, worse metabolic parameters and pregnancy outcomes. However, lower TSH or elevated higher thyroid hormone levels were linked to decreased BMD and increased fracture risk. Further data did not show substantial neurological and psychological outcomes, according to researchers.
These data suggest that treatment of even modest elevations in TSH levels may contribute to significant health benefits, according to Taylor and colleagues. However, further research is warranted in order to appropriately analyze the risks vs. benefits of treating patients with subclinical thyroid disease.
Disclosure: The researchers report no relevant financial disclosures.