This paper is behind a paywall, but its message is clear. When patients with SCH and TSH<10 units are treated with T4, heart parameters improve markedly. This is only accesible via a paywall, but its the conclusion which the most important, as it shows SCH can have effects that need attention.
The effect of early substitution of subclinical hypothyroidism on cardiovascular function
European Heart Journal: Acute Cardiovascular Care 12(Supplement_1)
DOI: 10.1093/ehjacc/zuad036.163M
Pandrc V, Kostovski D, Vranes J, et al
Written by
diogenes
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Brilliant. Thanks Diogenes. Doesn't this therefore indicate that they have the TSH level set too high before they can start treatment for hypothyroidism?
The effect of early substitution of subclinical hypothyroidism on cardiovascular function
M Pandrc, V Kostovski, D Vranes, A Ristic, J Ciric
European Heart Journal. Acute Cardiovascular Care, Volume 12, Issue Supplement_1, May 2023, zuad036.163, doi.org/10.1093/ehjacc/zuad...
Published:
03 May 2023
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background / Aim
Current controversies related to the treatment of subclinical hypothyroidism (SCH) with thyrotropin (TSH) < than 10 mU/L are based on the lack of evidence that levothyroxine therapy has beneficial effects. The aim of this study was to examine the effect a 3-month LT4 treatment on cardiovascular function in symptomatic SCH with TSH < 10 mIU/L.
Methods
Electro and echocardiographic indices were measured in 35 patients with persistent symptomatic SCH before the intervention (TSH 7.0±2.1 mIU/L), and 3 months after the euthyroid state had been achieved.
Results
Significant reduction in PR (before: 0.16 ± 0.02, after: 0.15 ± 0.02; p<0.001), QT (before: 389.58 ± 10.12, after: 383.54 ± 8.62; p<0.001) and QT corrected (before: 428.77 ± 20.11, after: 411.77 ± 14.73; p<0.001) intervals as well as increase in heart rate (p=0.001) were recorded in the group on levothyroxine therapy. The following parameters of the left and right ventricle were significantly decreased in the treatment group:
left ventricular mass index (before: 76.81 ± 13.52, after: 70.62 ± 16.45; p<0.001 respectively)
The increase was recorded as fractional shortening (before: 39.40 (35.40-46.80), after: 42.40 (38.80-47.20), p<0.001) and pressure rise in early systole (dP/dt: before: 2163.29 ± 454.48, after: 2385.17 ± 542.83; p<0.001),
right atrial wall thickness and diameters (RA long axis (before: 4.59 (4.18-5.11), after: 4.81 (4.31-5.70); p<0.001) and short axis (before: 3.67 (3.16-3.87), after: 3.88 (3.38-4.14); p<0.001)), wall thickness (before: 0.43 (0.40-0.46), after: 0.44 (0.40-0.48); p<0.001).
After the levothyroxine therapy, there was a statistically significant decrease in ESV and EDV (p<0.001, p<0.001 respectively). LT4 therapy significantly increased values of EF (p<0.001) as well as global longitudinal circumferential and radial strains (p<0.001, p<0.001, p<0.001 respectively).
There is a moderate, positive, statistically significant correlation between the change in the titre of anti TPO antibodies and the change in global longitudinal strain values after the therapy (p = 0.027).
Conclusions
Our study confirmed an echocardiographic improvement of cardiac structure and function in treated individuals. The findings suggest electrocardiographic and echocardiographic screening in monitoring the therapeutic effect.
End-systolic volume (ESV) is the volume of blood in a ventricle at the end of contraction, or systole, and the beginning of filling, or diastole.
In cardiovascular physiology, end-diastolic volume (EDV) is the volume of blood in the right or left ventricle at end of filling in diastole which is amount of blood present in ventricle at the end of diastole systole.
Mitral annular plane systolic excursion (MAPSE) has been proposed as a parameter for assessing left ventricular function.
The isovolumic contraction time (IVCT) is defined as the interval between the closing of the atrioventricular valves and the opening of the semilunar valves.
My understanding was that subclinical referred to non-symptomatic hypothyroidism which seemed nonsense because some symptoms (such as heart problems, elevated cholesterol etc) may be covert. If someone has a TSH above range, it seems negligent not to investigate and treat until the TSH reaches 10. What damage could the patient be exposed to in the meantime? Equally if the patient is symptomatic but subclinical, it's even more obvious that treatment should be considered rather than deferred until the TSH reaches 10. The medical profession knows best of course 🤔
Am sure it was tongue in cheek response 😂.... But in case there's any one on here who is literal....lol ... Do they know best though? No disrespect to the few who know their field well & have an open mind & are indeed effective clinicians . Most doctors I've met haven't a clue! Eg I've been very stable for years now on my thyroid medication (given the dose in all likelyhood my thyroid has long since ceased to function), with very simular blood levels for years, but a recent mess up of a blood test for thyroid hormones produced bogus results with amazing high level of thyroid hormones . Instead of contacting me to discuss an experienced GP automatically slashed medication by over a third (a level that would have left me horizontal) then text me the directive with no follow up let alone a consultation. If this is a knowledgeable clinician acting in a responsible way then I'll eat my hat! I'm tired of having to educate the medical profession on my clinical needs re hypothyroidism whilst reassuring their professional egos don't feel too bruised. The standard of care just keeps dropping not improving.
If only this information had been available twenty years ago I might have been spared a heart attack that no-one could find any reason for. Oh but somebody must have known something! One of the routine blood tests associated with investigating heart problems was to do a thyroid function test - results of which are immediately ignored! This ‘awareness’ has been around a very long time. The ‘tick box’ system is to make sure perhaps less informed medics undertake all relevant tests. However what is the point when the tests are ‘insufficient’ - no T3 tested and doctors do not know how to read the results of the test? So called ‘sub clinical’ hypothyroidism does not light any fires under medics no matter how important and bleak the symptoms! Ok so here we are again another twenty years on and still no changes within the incredibly arrogant medical profession. They apparently have super brains and we (especially hypothyroid patients) are dumb clucks.
Talking about this subclinical stuff I myself got a diagnosis off some thyroid specialist in 2014 (firstly let me tell you I never received the results, in that my gp never told me what was in the report, at that time I was very trusting in my doctors.. Not anymore)
Anyway the report which I eventually managed to read in 2020 after requesting my medical records said.. "She has a short suppressed TSH, along with a few episodes of thyroiditis (a swelling of the thyroid) this seems to be a case of subclinical HYPERthyroidism, I would therfore request this lady has regular blood tests to keep an eye on her thyroid function and hormone levels.
To my knowledge my gp never did this, I can't find one thyroid blood test done after this report, so I just became very ill over the next few years going back and forth to my surgery where I was told it was my menupausal state and eventually being told by this gp in August 2018 to stop bothering him he as far worse patients than me, 😭fast forward to the 18th sep 2018 when after another collapse at home my son yet again gets me to the surgery where I see a new gp(just started at the practice) she immediately diagnoses me on the spot.. "you have an overactive thyroid" turned out to be graves thyrotoxicosis, I went into thyroid storm and lost my thyroid in 2019.
I have to say this experience has tainted any faith I had in gps and some endocrinologist as my experience of them since my thyroidectomy is mind blowing as I really didn't know just how little they know about thyroid conditions😠 but yet every one I've met had this god complex and after learning so much about my thyroid condition on here I tried and failed to get the endos to understand what I'm going through, they just don't seem to care anymore it's all about the money.. Not the care😞😞
Yes birkie, I agree with what you say. Our trust has been betrayed and it may not dare be mentioned in public or the privacy of the consulting room. These guys are like automatons. When we move over to Artificial Intelligence (AI) we are unlikely to notice any difference. Our doctors already run on this programme. Their ‘protocols’ are a nightmare for some of us. From the inside looking out, thyroid issues are very affected by this. My view is that thyroid is a ‘wholistic’ disease and doctor training seems to be entirely unable to take that into consideration in its education. A brilliant bedside manner but without incisive thinking is no better. A blend of both would be welcome.
There are none so blind as those who will not see.
Noted that this relates to above 10 tsh .Query: Is there anything on cardiovascular/ thyroid ,research-wise, where there is tsh Hysteresis so that tsh is down regulated so can't go high BUT t4 is low ....just interested as recently made a small approach to GP who has no knowledge of Hysteresis ps looks l8ke I'm asking about Birkie's situation which I also have .
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