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CVD mortality linked to free T4, TSH levels
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The risk for cardiovascular disease mortality is raised with increasing free thyroxine levels and lower thyroid-stimulating hormone levels, according to findings published in The Journal of Clinical Endocrinology & Metabolism.
In a proof-of-concept study, Robin P. Peeters, MD, PhD, of the Rotterdam Thyroid Center, department of internal medicine, at Erasmus University Medical Center in the Netherlands, and colleagues evaluated data from the Rotterdam Study on 9,233 adults (mean age, 65 years) to determine the 10-year absolute risk for CVD mortality by the two most commonly used parameters of thyroid function: TSH and free T4. The researchers sought to define optimal health ranges for thyroid function.
Participants were followed for a median 8.8 years from baseline to date of death or end of follow-up in 2012.
Through follow-up, 2,166 deaths, including 689 CVD deaths, were recorded along with 642 coronary heart disease events and 553 stroke events.
Higher free T4 levels (P = .005) and lower TSH levels were associated with increased CVD mortality, but the association with TSH was not statistically significant. Researchers found a 9.6% predicted 10-year risk for CVD mortality associated with free T4 values about the 97th percentile and a 7.5% risk with free T4 levels about the 90th percentile. The risk for CVD mortality at the 97th percentile of free T4 was at least 10% and at least 7.5% at the 60th percentile in men; no association was found between risk for CVD mortality and thyroid function markers. The risk for CVD mortality increased with decreased TSH levels in participants younger than 65 years.
“We propose an approach to define thyroid function based not only on population’s distribution, but taking into account health and disease risk,” the researchers wrote. “We describe the absolute 10-year risk of CV mortality associated with TSH and [free T4] and provide an example of defining optimal health ranges based on CV mortality risk using data from a large population-based study. Further research is needed to investigate optimal health ranges based on thyroid-relevant clinical outcomes in sufficiently powered studies with representative samples from multiple populations.” – by Amber Cox
Disclosure: Peeters reports receiving lecture and consultancy fees from Genzyme and grant support from Veracyte. Please see the full study for a list of all other authors’ relevant financial disclosures.
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