Subclinical hypothyroidism: A common finding in... - Thyroid UK

Thyroid UK

140,281 members164,997 posts

Subclinical hypothyroidism: A common finding in adult patients with cyanotic congenital heart disease

helvella profile image
helvellaAdministratorThyroid UK
2 Replies

It hurts when I read papers like this one. They observe, examine prevalence, consider etiologies and evaluate thyroid function. And appear to leave the poor patients untreated. At least until it becomes "overt".

We might suspect that the categorisation of Subclinical Hypothyroidism wouldn't meet with widespread approval by members here?

Congenit Heart Dis. 2017 Dec 27. doi: 10.1111/chd.12565. [Epub ahead of print]

Subclinical hypothyroidism: A common finding in adult patients with cyanotic congenital heart disease.

Bak P1, Hjortshøj CS2, Gaede P3, Idorn L4, Søndergaard L2, Jensen AS2.

Author information

1 Department of Anesthesiology, North Zealand Hospital, Hillerod, Denmark.

2 Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.

3 Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark.

4 Department of Pediatrics, Rigshospitalet, Copenhagen, Denmark.

Abstract

OBJECTIVE:

Cyanotic congenital heart disease is a systemic disease, with effects on multiple organ systems. A high prevalence of subclinical hypothyroidism (SCH) has been reported in a small cohort of cyanotic congenital heart disease patients. Subclinical hypothyroidism has been associated with various adverse cardiovascular effects, as well as an increased risk of progression to overt hypothyroidism. The aim of this study was to examine the prevalence of SCH in cyanotic congenital heart disease patients, consider possible etiologies, and evaluate thyroid function over time.

METHODS:

First, 90 clinically stable cyanotic congenital heart disease patients were examined with blood samples (thyroid-stimulating hormone, C-reactive protein, hemoglobin, hematocrit, and N-terminal pro-brain-natriuretic peptide) in a cross-sectional descriptive study. Second, a longitudinal follow-up study of 43 patients originating from the first study part, was carried out. These patients had thyroid function parameters (thyroid-stimulating hormone, thyroid hormones, and thyroid peroxidase antibodies) evaluated biannually.

RESULTS:

Elevated thyroid-stimulating hormone was present in 24% of the 90 screened patients. During follow-up (6.5 ± 1.0 years), SCH (defined as ≥2 consecutive elevated thyroid-stimulating hormone values) was present in 26%. Three patients progressed to overt hypothyroidism. Patients with SCH were younger (34 ± 12 vs 42 ± 16 years; P = .01) and had a lower oxygen saturation (80 ± 5 vs 84 ± 6%; P = .03).

CONCLUSION:

Subclinical hypothyroidism is a very common finding in cyanotic congenital heart disease. This is not associated with increased levels of C-reactive protein, heart failure, or autoimmunity but appears to be associated with cyanosis and age. Since the clinical impact of SCH is uncertain, further studies are needed to determine this. Regular thyroid evaluation is recommended in cyanotic congenital heart disease patients since SCH can develop to overt hypothyroidism.

© 2017 Wiley Periodicals, Inc.

KEYWORDS:

cyanosis; cyanotic congenital heart disease; subclinical hypothyroidism; thyroid-stimulating hormone

PMID: 29280293

DOI: 10.1111/chd.12565

ncbi.nlm.nih.gov/pubmed/292...

Written by
helvella profile image
helvella
Administrator
To view profiles and participate in discussions please or .
Read more about...
2 Replies
Spareribs profile image
Spareribs

And the usual statement "further studies needed" boys

shaws profile image
shawsAdministrator

My heart drops when I read similar to the above. These patients have been used as guinea pigs but have they been treated for subclinical or left to get on with things, considering they have a congenital disability in the first place.

Not what you're looking for?

You may also like...

Effect of iodine restriction on thyroid function in subclinical hypothyroid patients in an iodine-replete area

I told you that iodine is controversial. :-) Thyroid. 2014 Jun 3. [Epub ahead of......

Changes of bone mineral density and bone metabolic marker in patients with subclinical hypothyroidism

Can someone please explain why medics are utterly obsessed with over-treatment causing lowered bone...

Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism

I was thinking "There disappears your chance of getting treated if you are over 65." Then I...

Maternal thyroid disorder in pregnancy and risk of cerebral palsy in the child: a population-based cohort study

It is difficult to know quite how much of a finding this is. I suspect we in the UK might question...

Association between dietary onion intake and subclinical hypothyroidism in adults: a population-based study from an iodine-replete area

What a very odd paper - which really doesn't get anywhere in terms of explanation. Nonetheless, it...