S A Paul Chubb1,2, Kirsten E Peters1, David G Bruce1, Wendy A Davis1, Timothy M E Davis3. 1. Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia. 2. PathWest Laboratory Medicine Western Australia, Fiona Stanley Hospital, Murdoch, WA, Australia. 3. Medical School, Faculty of Health and Medical Sciences, Fremantle Hospital, University of Western Australia, PO Box 480, Fremantle, WA, 6959, Australia. tim.davis@uwa.edu.au.
Abstract
AIMS: It is uncertain whether subclinical thyroid dysfunction is associated with cardiovascular disease (CVD) events and mortality in people with type 2 diabetes. The aim of this study was to determine whether undetected thyroid disease increases the risk of incident CVD and death in type 2 diabetes. METHODS: One thousand two hundred fifty participants with type 2 diabetes (mean age 65.3 years, 56.5% males, median diabetes duration 8.0 years) without known thyroid disease and not taking medications known to affect thyroid function were categorised, based on baseline serum free thyroxine (FT4) and thyrotropin (TSH) concentrations, as euthyroid, overt hypothyroid (increased TSH, low FT4), subclinical hypothyroid (increased TSH, normal FT4), overt thyrotoxic (decreased TSH, raised FT4) or subclinical thyrotoxic (decreased TSH, normal FT4). Incident myocardial infarction, incident stroke, all-cause and cardiovascular mortality were ascertained during a mean 6.2-6.7 years of follow-up. RESULTS: Most participants with newly-detected thyroid dysfunction had subclinical hypothyroidism (77.2%) while overt/subclinical thyrotoxicosis was infrequent. Compared to participants with TSH 0.34-2.9 mU/L, those with TSH > 5.1 mU/L were not at increased risk of incident myocardial infarction (adjusted hazard ratio (95% confidence limits) 1.77 (0.71, 2.87)), incident stroke (1.66 (0.58, 4.78)), all-cause mortality (0.78 (0.44, 1.37)) or cardiovascular mortality (1.16 (0.38, 3.58)). Independent baseline associates of subclinical hypothyroidism included estimated glomerular filtration rate and systolic blood pressure. CONCLUSIONS: Subclinical hypothyroidism was not independently associated with CVD events or mortality in community-dwelling people with type 2 diabetes despite its associations with CVD risk factors, questioning strategies to identify and/or treat mild thyroid dysfunction outside usual care.
AIMS: It is uncertain whether subclinical thyroid dysfunction is associated with cardiovascular disease (CVD) events and mortality in people with type 2 diabetes. The aim of this study was to determine whether undetected thyroid disease increases the risk of incident CVD and death in type 2 diabetes. METHODS: One thousand two hundred fifty participants with type 2 diabetes (mean age 65.3 years, 56.5% males, median diabetes duration 8.0 years) without known thyroid disease and not taking medications known to affect thyroid function were categorised, based on baseline serum free thyroxine (FT4) and thyrotropin (TSH) concentrations, as euthyroid, overt hypothyroid (increased TSH, low FT4), subclinical hypothyroid (increased TSH, normal FT4), overt thyrotoxic (decreased TSH, raised FT4) or subclinical thyrotoxic (decreased TSH, normal FT4). Incident myocardial infarction, incident stroke, all-cause and cardiovascular mortality were ascertained during a mean 6.2-6.7 years of follow-up. RESULTS: Most participants with newly-detected thyroid dysfunction had subclinical hypothyroidism (77.2%) while overt/subclinical thyrotoxicosis was infrequent. Compared to participants with TSH 0.34-2.9 mU/L, those with TSH > 5.1 mU/L were not at increased risk of incident myocardial infarction (adjusted hazard ratio (95% confidence limits) 1.77 (0.71, 2.87)), incident stroke (1.66 (0.58, 4.78)), all-cause mortality (0.78 (0.44, 1.37)) or cardiovascular mortality (1.16 (0.38, 3.58)). Independent baseline associates of subclinical hypothyroidism included estimated glomerular filtration rate and systolic blood pressure. CONCLUSIONS: Subclinical hypothyroidism was not independently associated with CVD events or mortality in community-dwelling people with type 2 diabetes despite its associations with CVD risk factors, questioning strategies to identify and/or treat mild thyroid dysfunction outside usual care.
Authors: Christiane Drechsler; Andreas Schneider; Lena Gutjahr-Lengsfeld; Matthias Kroiss; Juan Jesús Carrero; Vera Krane; Bruno Allolio; Christoph Wanner; Martin Fassnacht Journal: Am J Kidney Dis Date: 2013-12-04 Impact factor: 8.860
Authors: Nicolas Rodondi; Wendy P J den Elzen; Douglas C Bauer; Anne R Cappola; Salman Razvi; John P Walsh; Bjørn O Asvold; Giorgio Iervasi; Misa Imaizumi; Tinh-Hai Collet; Alexandra Bremner; Patrick Maisonneuve; José A Sgarbi; Kay-Tee Khaw; Mark P J Vanderpump; Anne B Newman; Jacques Cornuz; Jayne A Franklyn; Rudi G J Westendorp; Eric Vittinghoff; Jacobijn Gussekloo Journal: JAMA Date: 2010-09-22 Impact factor: 56.272
Authors: Layal Chaker; Christine Baumgartner; Wendy P J den Elzen; M Arfan Ikram; Manuel R Blum; Tinh-Hai Collet; Stephan J L Bakker; Abbas Dehghan; Christiane Drechsler; Robert N Luben; Albert Hofman; Marileen L P Portegies; Marco Medici; Giorgio Iervasi; David J Stott; Ian Ford; Alexandra Bremner; Christoph Wanner; Luigi Ferrucci; Anne B Newman; Robin P Dullaart; José A Sgarbi; Graziano Ceresini; Rui M B Maciel; Rudi G Westendorp; J Wouter Jukema; Misa Imaizumi; Jayne A Franklyn; Douglas C Bauer; John P Walsh; Salman Razvi; Kay-Tee Khaw; Anne R Cappola; Henry Völzke; Oscar H Franco; Jacobijn Gussekloo; Nicolas Rodondi; Robin P Peeters Journal: J Clin Endocrinol Metab Date: 2015-04-09 Impact factor: 5.958
Authors: Yu Ning; Yun J Cheng; Li J Liu; Jaskanwal D S Sara; Zhi Y Cao; Wei P Zheng; Tian S Zhang; Hui J Han; Zhen Y Yang; Yi Zhang; Fei L Wang; Rui Y Pan; Jie L Huang; Ling L Wu; Ming Zhang; Yong X Wei Journal: BMC Med Date: 2017-02-02 Impact factor: 8.775