Vita tárgyát képezi, vajon a szubklinikus hypothyreosis káros hatást fejt-e ki a cardiovascularis rendszerre, amelynek a következménye megnövekedett morbiditás és mortalitás. Ennek a tisztázására számos epidemiológiai vizsgálatot végeztek, mégis ez idáig ezek nem adtak egyértelmű választ. A vizsgálatok kiértékelését számos zavaró körülmény befolyásolja, márpedig ezeket tekintetbe kell venni. A szerzők a TSH-vizsgálat végzésekor életkor-specifikus referenciatartomány meghatározását ajánlják, mivel az életkor előrehaladtával a TSH-szint magasabb érték felé tolódik el. Így elkerülhető lenne kissé emelkedett TSH-szintű idősebb betegek helytelen besorolása a szubklinikus hypothyreosisos csoportba. Újabb vizsgálatok arra utalnak, hogy szubklinikus hypothyreosisban a cardiovascularis betegség kockázata elsősorban a 65 életévnél fiatalabbakon növekszik meg. Ezt a lehetőséget is tekintetbe véve, a jövőben jól tervezett, prospektív, randomizált vizsgálatok elvégzése szükséges, amelyekben tekintetbe veszik a betegek életkorát, a vascularis eseményeket pedig elsődleges végpontnak tekintik. Remélhetőleg ezek megadják majd a választ arra a kérdésre is, vajon a tiroxinnal végzett korai szubsztitúciós kezelés megakadályozhatja-e ezen betegekben az ischaemiás szívbetegség kifejlődését. Orv. Hetil., 2010, 37, 1488–1494.
Kahaly, G. J., Dillmann, W. H.: Thyroid hormone action in the heart. Endocrine Rev., 2005, 26 , 704–728.
Dillmann W. H. , 'Thyroid hormone action in the heart ' (2005 ) 26 Endocrine Rev. : 704 -728 .
Klein, J., Danzi, S.: Thyropid disease and the heart. Circulation, 2007, 116 , 1725–1735.
Danzi S. , 'Thyropid disease and the heart ' (2007 ) 116 Circulation : 1725 -1735 .
Biondi, B., Palmieri, E. A., Lombardi, G. és mtsa: Subclinical hypothyroidism and cardiac function. Thyroid, 2002, 12 , 505–512.
Lombardi G. , 'Subclinical hypothyroidism and cardiac function ' (2002 ) 12 Thyroid : 505 -512 .
Biondi, B.: Cardiovascular effects of mild hypothyroidism. Thyroid, 2007, 17 , 625–630.
Biondi B. , 'Cardiovascular effects of mild hypothyroidism ' (2007 ) 17 Thyroid : 625 -630 .
Brenta, G., Mutti, L. A., Schnitman, M. és mtsai: Assessment of left ventricular diastolic function by radionuclide ventriculography at rest and exercise in subclinical hypothyroidism and its response to L-thyroxine therapy. Am. J. Cardiol., 2003, 91 , 1322–1330.
Schnitman M. , 'Assessment of left ventricular diastolic function by radionuclide ventriculography at rest and exercise in subclinical hypothyroidism and its response to L-thyroxine therapy ' (2003 ) 91 Am. J. Cardiol. : 1322 -1330 .
Ripoli, A., Pingitore, A., Favilli, B. és mtsai: Does subclinical hypothyroidism affect cardiac pump performance? Evidence from a magnetic resonance imaging study. J. Am. Coll. Cardiol., 2005, 45 , 439–445.
Favilli B. , 'Does subclinical hypothyroidism affect cardiac pump performance? Evidence from a magnetic resonance imaging study ' (2005 ) 45 J. Am. Coll. Cardiol. : 439 -445 .
Földes J., Bános Cs., Winkler G.: Szubklinikus hypothyreosis és arteriosclerosis. Orv. Hetil., 2004, 145 , 1601–1607.
Winkler G. , 'Szubklinikus hypothyreosis és arteriosclerosis ' (2004 ) 145 Orv. Hetil. : 1601 -1607 .
Owen, P. J., Sabil, R., Lazarus, J. H.: Thyroid disease and vascular function. Thyroid, 2007, 17 , 519–524.
Lazarus J. H. , 'Thyroid disease and vascular function ' (2007 ) 17 Thyroid : 519 -524 .
Biondi, B., Cooper, D. S.: The clinical significance of subclinical thyroid dysfunction. Endocrine Rev., 2008, 29 , 76–131.
Cooper D. S. , 'The clinical significance of subclinical thyroid dysfunction ' (2008 ) 29 Endocrine Rev. : 76 -131 .
Lekakis, J., Papamichael, C., Alevizaki, M. és mtsai: Flow mediated, endothelium dependent vasodilatation is impaired in hypothyroidism and high normal serum thyrotropin values. Thyroid, 1997, 7 , 411–414.
Alevizaki M. , 'Flow mediated, endothelium dependent vasodilatation is impaired in hypothyroidism and high normal serum thyrotropin values ' (1997 ) 7 Thyroid : 411 -414 .
Razvi, S., Ingoe, L., Kecka, G. és mtsai: The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function and quality of life subclinical hypothyroidism: randomized, crossover trial. J. Clin. Endocrinol. Metab., 2007, 92 , 1715–1723.
Kecka G. , 'The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function and quality of life subclinical hypothyroidism: randomized, crossover trial ' (2007 ) 92 J. Clin. Endocrinol. Metab. : 1715 -1723 .
Owen, P. J., Rajiv, C., Vinereanu, D. és mtsai: Subclinical hypothyroidism, arterial stiffness and myocardial reserve. J. Clin. Endocrinol. Metab., 2006, 91 , 2126–2132.
Vinereanu D. , 'Subclinical hypothyroidism, arterial stiffness and myocardial reserve ' (2006 ) 91 J. Clin. Endocrinol. Metab. : 2126 -2132 .
Peleg, R. K., Efrati, S., Benbassat, C. és mtsai: The effect of levothyroxine on arterial stiffness and lipid profile in patients with subclinical hypothyroidism. Thyroid, 2008, 18 , 825–830.
Benbassat C. , 'The effect of levothyroxine on arterial stiffness and lipid profile in patients with subclinical hypothyroidism ' (2008 ) 18 Thyroid : 825 -830 .
Monzani, F., Caraccio, N., Kozakowa, M. és mtsai: Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism. J. Clin. Endocrinol. Metab., 2004, 89 , 2099–2106.
Kozakowa M. , 'Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism ' (2004 ) 89 J. Clin. Endocrinol. Metab. : 2099 -2106 .
Chadarevian, R., Bruckerb, E., Leenhardt, L. és mtsai: Components of the fibrinolytic system are differently altered in moderate and severe hypothyroidism. J. Clin. Endocrinol. Metab., 2001, 86 , 732–737.
Leenhardt L. , 'Components of the fibrinolytic system are differently altered in moderate and severe hypothyroidism ' (2001 ) 86 J. Clin. Endocrinol. Metab. : 732 -737 .
Canturk, N. Z., Catinaslan, B., Tarkun, J. és mtsai: Haemostatic system as a risk factor for cardiovascular disease in women with subclinical hypothyroidism. Thyroid, 2003, 13 , 971–977.
Tarkun J. , 'Haemostatic system as a risk factor for cardiovascular disease in women with subclinical hypothyroidism ' (2003 ) 13 Thyroid : 971 -977 .
Tuzcu, A., Bahceci, M., Gokalp, D. és mtsai: Subclinical hypothyroidism may be associated with elevated high-sensitive C-reactive protein and fasting hyperinzulinemia. Endocr. J., 2005, 52 , 89–94.
Gokalp D. , 'Subclinical hypothyroidism may be associated with elevated high-sensitive C-reactive protein and fasting hyperinzulinemia ' (2005 ) 52 Endocr. J. : 89 -94 .
Hueston, W. J., King, D. E., Geesey, M. E.: Serum biomarkers for cardiovascular inflammation in subclinical hypothyroidism. Clin. Endocrinol., 2005, 63 , 582–587.
Geesey M. E. , 'Serum biomarkers for cardiovascular inflammation in subclinical hypothyroidism ' (2005 ) 63 Clin. Endocrinol. : 582 -587 .
Heinonen, O. P., Gardin, A., Aho, K. és mtsai: Symptomless autoimmun thyroiditis in coronary heart disease. Lancet, 1972, 8 , 785–786.
Aho K. , 'Symptomless autoimmun thyroiditis in coronary heart disease ' (1972 ) 8 Lancet : 785 -786 .
Tieshe, M., Lupi, G. H., Gutzwiller, F. és mtsai: Borderline low thyroid function and thyroid autoimmunity. Risk factors for coronary heart disease? Brit. Heart J., 1981, 46 , 202–206.
Gutzwiller F. , 'Borderline low thyroid function and thyroid autoimmunity. Risk factors for coronary heart disease? ' (1981 ) 46 Brit. Heart J. : 202 -206 .
Lindeman, R. D., Schade, D. S., La Rue, H. és mtsa: Subclinical hypothyroidism in a biethnic urban community. J. Am. Geriatr. Soc., 1999, 47 , 703–709.
Rue H. , 'Subclinical hypothyroidism in a biethnic urban community ' (1999 ) 47 J. Am. Geriatr. Soc. : 703 -709 .
Hak, A. E., Pols, H. A. P., Visser, Th. J. és mtsai: Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study. Ann. Intern. Med., 2000, 132 , 270–278.
Visser Th. J. , 'Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: The Rotterdam Study ' (2000 ) 132 Ann. Intern. Med. : 270 -278 .
Imaizumi, M., Akahoshi, M., Ichimaru, S. és mtsai: Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism. J. Clin. Endocrinol. Metab., 2004, 89 , 3365–3370.
Ichimaru S. , 'Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism ' (2004 ) 89 J. Clin. Endocrinol. Metab. : 3365 -3370 .
Walsh, J. P., Bremner, A. P., Bulsara, M. K. és mtsai: Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch. Intern. Med., 2005, 165 , 2467–2472.
Bulsara M. K. , 'Subclinical thyroid dysfunction as a risk factor for cardiovascular disease ' (2005 ) 165 Arch. Intern. Med. : 2467 -2472 .
Kvetny, J., Heldgaard, P. E., Bladbjerg, E. M. és mtsai: Subclinical hypothyroidism with a low-grade inflammation, increased trigliceride levels and predicts cardiovascular disease in males below 50 years. Clin. Endocrinol., 2004, 61 , 232–238.
Bladbjerg E. M. , 'Subclinical hypothyroidism with a low-grade inflammation, increased trigliceride levels and predicts cardiovascular disease in males below 50 years ' (2004 ) 61 Clin. Endocrinol. : 232 -238 .
Vanderpump, M. R., Tunbridge, W. M., French, J. M. és mtsai: The development of ischemic heart disease in a 20-year follow-up study of an English community. Thyroid, 1996, 6 , 155–160.
French J. M. , 'The development of ischemic heart disease in a 20-year follow-up study of an English community ' (1996 ) 6 Thyroid : 155 -160 .
Parle, J. V., Maisonneuve, P., Sheppard, M. C. és mtsai: Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study. Lancet, 2001, 358 , 861–865.
Sheppard M. C. , 'Prediction of all-cause and cardiovascular mortality in elderly people from one low serum thyrotropin result: a 10-year cohort study ' (2001 ) 358 Lancet : 861 -865 .
Gussekloo, J., van Exel, E., de Craen, A. J. és mtsai: Thyroid status, disability, cognitive function and survival in old age. JAMA, 2004, 292 , 2591–2599.
Craen A. J. , 'Thyroid status, disability, cognitive function and survival in old age ' (2004 ) 292 JAMA : 2591 -2599 .
van den Beld, H. W., Visser, T. J., Felders, R. A. és mtsai: Thyroid hormone concentrations, disease, physical function and mortality in elderly men. J. Clin. Endocrinol. Metab., 2005, 90 , 6403–6405.
Felders R. A. , 'Thyroid hormone concentrations, disease, physical function and mortality in elderly men ' (2005 ) 90 J. Clin. Endocrinol. Metab. : 6403 -6405 .
Cappola, A. R., Fried, L. R., Arnold A. és mtsai: Thyroid status, cardiovascular risk and mortality in older adults. JAMA, 2006, 295 , 1033–1041.
Arnold A. , 'Thyroid status, cardiovascular risk and mortality in older adults ' (2006 ) 295 JAMA : 1033 -1041 .
Rodondi, N., Neuman, A. R., Vittinghoff, E. és mtsai: Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events and death. Arch. Intern. Med., 2005, 165 , 2460–2466.
Vittinghoff E. , 'Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events and death ' (2005 ) 165 Arch. Intern. Med. : 2460 -2466 .
Razvi, S., Weaver, J. U., Vanderpump, M. P. és mtsai: The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: Reanalysis of the Whickham survey cohort. J. Clin. Endocrinol. Metab., 2010, 95 , 1734–1740.
Vanderpump M. P. , 'The incidence of ischemic heart disease and mortality in people with subclinical hypothyroidism: Reanalysis of the Whickham survey cohort ' (2010 ) 95 J. Clin. Endocrinol. Metab. : 1734 -1740 .
Völzke, H., Schwahn, Ch., Wallaschofski, H. és mtsa: Review: the association of thyroid dysfunction with all-cause and circulatory mortality: Is there a causal relationship? J. Clin. Endocrinol. Metab., 2007, 92 , 2421–2429.
Wallaschofski H. , 'Review: the association of thyroid dysfunction with all-cause and circulatory mortality: Is there a causal relationship? ' (2007 ) 92 J. Clin. Endocrinol. Metab. : 2421 -2429 .
Singh, S., Duggal, J., Molnar, J. és mtsai: Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: a meta-analysis. Intern. J. Cardiol., 2008, 125 , 41–48.
Molnar J. , 'Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: a meta-analysis ' (2008 ) 125 Intern. J. Cardiol. : 41 -48 .
Rodondi, N., Aujeski, D., Vittinghoff, E. és mtsai: Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis. Amer. J. Medicine, 2006, 119 , 541–551.
Vittinghoff E. , 'Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis ' (2006 ) 119 Amer. J. Medicine : 541 -551 .
Ochs, N., Auer, R., Bauer, D. C. és mtsai: Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality. Ann. Intern. Med., 2008, 148 , 812–845.
Bauer D. C. , 'Meta-analysis: subclinical thyroid dysfunction and the risk for coronary heart disease and mortality ' (2008 ) 148 Ann. Intern. Med. : 812 -845 .
Razvi, S., Shakoor, A., Vanderpump, M. és mtsai: The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a meta-analysis. J. Clin. Endocrinol. Metab., 2008, 93 , 2998–3007.
Vanderpump M. , 'The influence of age on the relationship between subclinical hypothyroidism and ischemic heart disease: a meta-analysis ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 2998 -3007 .
Hollowell, J. G., Staehling, N. W., Flanders, W. D. és mtsai: Serum TSH, T 4 and thyroid antibodies in the United States population: National Health and Nutrition Examination Survey (NHANES III). J. Clin. Endocrinol. Metab., 2002, 87 , 489–499.
Flanders W. D. , 'Serum TSH, T4 and thyroid antibodies in the United States population: National Health and Nutrition Examination Survey (NHANES III) ' (2002 ) 87 J. Clin. Endocrinol. Metab. : 489 -499 .
Surks, M. J., Hollowell, J. G.: Age specific distribution of serum TSH and antithyroid antibodies in the United States population; implications for the prevalance of subclinical hypothyroidism. J. Clin. Endocrinol. Metab., 2007, 92 , 4575–4582.
Hollowell J. G. , 'Age specific distribution of serum TSH and antithyroid antibodies in the United States population; implications for the prevalance of subclinical hypothyroidism ' (2007 ) 92 J. Clin. Endocrinol. Metab. : 4575 -4582 .
Surks, M. J., Boncai, L.: Age and race-based serum thyrotropin reference limits. J. Clin. Endocrinol. Metab., 2010, 95 , 496–502.
Boncai L. , 'Age and race-based serum thyrotropin reference limits ' (2010 ) 95 J. Clin. Endocrinol. Metab. : 496 -502 .
Boncai, L., Surks, M. I.: Reference limits of serum thyrotropin and free-thyroxine are significantly influenced by race and age in an urban outpatient practice of medicine. Clin. Endocrinol., 2009, 70 , 788–793.
Surks M. I. , 'Reference limits of serum thyrotropin and free-thyroxine are significantly influenced by race and age in an urban outpatient practice of medicine ' (2009 ) 70 Clin. Endocrinol. : 788 -793 .
Atzman, G., Barzilai, N., Surks, M. J. és mtsai: Genetic predisposition to elevated thyrotropin is associated with exceptional longenity. J. Clin. Endocrinol. Metab., 2009, 94 , 4768–4775.
Surks M. J. , 'Genetic predisposition to elevated thyrotropin is associated with exceptional longenity ' (2009 ) 94 J. Clin. Endocrinol. Metab. : 4768 -4775 .
Atzman, G., Barzilai, N., Hollowell, J. G. és mtsa: Extreme longenity is associated with increased serum thyrotropin. J. Clin. Endocrinol. Metab., 2009, 94 , 1251–1254.
Hollowell J. G. , 'Extreme longenity is associated with increased serum thyrotropin ' (2009 ) 94 J. Clin. Endocrinol. Metab. : 1251 -1254 .
Wartofsky, L., Dickey, R. A.: Controversy in clinical endocrinology: the evidence for a narrower thyrotropin reference range is compelling. J. Clin. Endocrinol. Metab., 2005, 90 , 5483–5488.
Dickey R. A. , 'Controversy in clinical endocrinology: the evidence for a narrower thyrotropin reference range is compelling ' (2005 ) 90 J. Clin. Endocrinol. Metab. : 5483 -5488 .
Surks, M. J., Goswami, G., Daniels, G. H.: Controversy in clinical endocrinology: the thyrotropin reference range should remain unchanged. J. Clin. Endocrinol. Metab., 2005, 90 , 5489–5496.
Daniels G. H. , 'Controversy in clinical endocrinology: the thyrotropin reference range should remain unchanged ' (2005 ) 90 J. Clin. Endocrinol. Metab. : 5489 -5496 .
Mariotti, S.: Mild hypothyroidism and ischemic heart disease: Is age the answer? J. Clin. Endocrinol. Metab., 2008, 93 , 2969–2971.
Mariotti S. , 'Mild hypothyroidism and ischemic heart disease: Is age the answer? ' (2008 ) 93 J. Clin. Endocrinol. Metab. : 2969 -2971 .