Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz (UMED), Lodz, Poland.
Department of Cardiology and Congenital Diseases of Adults, Polish Mother's Memorial Hospital Research Institute (ICZMP), Lodz, Poland.
Clin Res Cardiol. 2019 Mar;108(3):225-233. doi: 10.1007/s00392-018-1340-1. Epub 2018 Aug 8.
The prevalence of subclinical hypothyroidism (SCH) ranges from 5 to 15% of the general population. However, it remains controversial if SCH warrants life-long thyroxine replacement therapy. Patients with a thyroid-stimulating hormone (TSH) level > 10 mIU/L have a higher risk of developing heart failure with reduced ejection fraction as compared to subjects with normal thyroid function. However, abnormally high TSH levels could also be connected with an overall lower metabolic rate and better survival in elderly subjects. The potential mechanisms responsible for diastolic dysfunction of the left ventricle (LV) in SCH are connected with endothelial dysfunction and arterial stiffness, inflammatory state and are driven by TSH apoptosis-derived microparticles. The impact of SCH on LV systolic function is more controversial, and it is connected not only with cardiac remodelling but also with predisposition of patients with SCH to the conditions leading to heart failure. This review presents an overview of processes in the context of potential benefits of thyroxine supplementation therapy.
亚临床甲状腺功能减退症（SCH）的患病率在普通人群中为 5%至 15%。然而，SCH 是否需要终身甲状腺素替代治疗仍存在争议。与甲状腺功能正常的受试者相比，促甲状腺激素（TSH）水平>10mIU/L 的患者发生射血分数降低性心力衰竭的风险更高。然而，异常高的 TSH 水平也可能与老年人整体较低的代谢率和更好的生存有关。SCH 导致左心室（LV）舒张功能障碍的潜在机制与内皮功能障碍和动脉僵硬、炎症状态有关，并由 TSH 凋亡衍生的微粒驱动。SCH 对 LV 收缩功能的影响更具争议性，它不仅与心脏重构有关，而且与 SCH 患者易患导致心力衰竭的疾病有关。这篇综述概述了潜在甲状腺素补充治疗获益方面的相关过程。
