Abstract
Context: The relationship between thyroid dysfunction and measures of myocardial disease in older individuals remains to be defined. Objective: To evaluate the impact of thyroid dysfunction on structure and function of the left heart chambers and blood markers of cardiac disease. Methods: Cross-sectional analysis of the Cardiovascular Health Study, a community-based cohort of older individuals recruited from 4 urban areas in the United States. Of 3163 participants studied, 2477 were euthyroid, 465 had subclinical hypothyroidism (SCH), 47 overt hypothyroidism (OH), 45 endogenous (endo) subclinical hyperthyroidism (endo-SCT), and 129 had exogenous (exo) SCT due to thyroid hormone supplementation. Participants underwent clinical evaluation, blood sampling and biomarker measurement, 2-dimensional and speckle tracking echocardiography for assessment of left heart myocardial deformation, circulating biomarkers of diastolic overload (NT-proBNP), fibrosis (sST2, gal-3), and cardiomyocyte injury (hs-cTnT). Results: SCH was associated with higher NT-proBNP (beta = 0.17, P =. 004), whereas OH was associated with higher hs-cTnT (beta = 0.29, P =. 005). There were also suggestive associations of SCH with higher sST2, as well as endo-SCT with higher gal-3 and lower (worse) left atrial reservoir strain. Left ventricular longitudinal strain and end diastolic strain rate did not differ significantly from euthyroid participants in SCH, OH, or exo-SCT. Conclusion: In this free-living elderly cohort, subclinical and overt hypothyroidism were associated with abnormalities of blood biomarkers consistent with diastolic overload and myocardial necrosis respectively, whereas subclinical hyperthyroidism tended to be associated with myocardial fibrosis and decreased left atrial strain. Our findings could represent stage B heart failure and illuminate distinct aspects of the pathobiology of heart disease related to thyroid gland dysfunction with potential clinical implications.
| Original language | English (US) |
|---|---|
| Pages (from-to) | e1847-e1856 |
| Journal | Journal of clinical endocrinology and metabolism |
| Volume | 109 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2024 |
Funding
This research was supported by contracts HHSN268201200036C, HHSN268200800007C, HHSN268201800001C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, 75N92021D00006, and grants U01HL080295 and U01HL130114 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA), St. Francis Hospital Foundation, Roslyn NY. A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Keywords
- biomarkers
- cardiac mechanics
- subclinical hyperthyroidism
- subclinical hypothyroidism
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Biochemistry
- Endocrinology
- Clinical Biochemistry
- Biochemistry, medical
