Baretella Oliver, Blum Manuel R, Abolhassani Nazanin, Alwan Heba, Wildisen Lea, Del Giovane Cinzia, Tal Kali, Moutzouri Elisavet, Åsvold Bjørn O, Cappola Anne R, Gussekloo Jacobijn, Iacoviello Massimo, Iervasi Giorgio, Imaizumi Misa, Weiler Stefan, Razvi Salman, Sgarbi José A, Völzke Henry, Brown Suzanne J, Walsh John P, Vaes Bert, Yeap Bu B, Dullaart Robin P F, Bakker Stephan J L, Kavousi Maryam, Ceresini Graziano, Ferrucci Luigi, Aujesky Drahomir, Peeters Robin P, Bauer Douglas C, Feller Martin, Rodondi Nicolas
Institute of Primary Health Care (BIHAM), University of Bern, 3012 Bern, Switzerland.
Department of General Internal Medicine, Inselspital, Bern University Hospital, 3010 Bern, Switzerland.
J Clin Endocrinol Metab. 2025 Apr 22;110(5):e1315-e1322. doi: 10.1210/clinem/dgae860.
Subclinical thyroid dysfunction (ScTD), comprising subclinical hypothyroidism (SHypo) and subclinical hyperthyroidism (SHyper), has been associated with increased risk for cardiovascular events.
To assess associations between ScTD and cardiovascular risk factors (cvRFs) according to age and sex.
This analysis of pooled participant data from large prospective cohort studies from the Thyroid Studies Collaboration assessed cvRFs (blood pressure [BP], lipid levels, high-sensitivity C-reactive protein [hs-CRP]) among participants aged 18 to 103 years with SHypo (thyroid-stimulating hormone [TSH] > 4.50 mU/L, normal fT4) and SHyper (TSH < 0.45 mU/L, normal fT4) vs euthyroid (TSH 0.45-4.50 mU/L).
Of 69 006 participants (mean age 62 years, 55% women, 25% current smokers) from 16 international cohorts, 3748 (5.4%) had SHypo and 3428 (5.0%) had SHyper. In both women and men, systolic and diastolic BP were similar regardless of thyroid status. Exceptions were lower diastolic BP in women with SHyper compared to euthyroid participants (adjusted mean difference [aMD] -1.3 mmHg, 95% CI -2.0 to -0.5), and lower systolic BP in men with SHyper compared to euthyroid participants (aMD -3.1 mmHg, 95% CI -4.8 to -1.4). In both women and men, lipid levels (total, HDL, LDL-cholesterol, triglycerides) and hs-CRP were similar regardless of thyroid status. The only exception were women with SHyper who had lower LDL-cholesterol vs euthyroid (aMD -0.17 mmol/L, 95% CI -0.29 to -0.05).
Participants with ScTD and euthyroid participants have similar cvRFs and differences are arguably too small to explain the increased cardiovascular risk in ScTD observed in previous studies.
亚临床甲状腺功能障碍（ScTD），包括亚临床甲状腺功能减退（SHypo）和亚临床甲状腺功能亢进（SHyper），与心血管事件风险增加有关。
根据年龄和性别评估ScTD与心血管危险因素（cvRFs）之间的关联。
本分析汇总了甲状腺研究协作组大型前瞻性队列研究的参与者数据，评估了年龄在18至103岁之间的SHypo（促甲状腺激素[TSH]>4.50 mU/L，游离甲状腺素[fT4]正常）、SHyper（TSH<0.45 mU/L，fT4正常）与甲状腺功能正常（TSH 0.45 - 4.50 mU/L）参与者的cvRFs（血压[BP]、血脂水平、高敏C反应蛋白[hs-CRP]）。
在来自16个国际队列的69006名参与者（平均年龄62岁，55%为女性，25%为当前吸烟者）中，3748人（5.4%）患有SHypo，3428人（5.0%）患有SHyper。在女性和男性中，无论甲状腺状态如何，收缩压和舒张压都相似。例外情况是，与甲状腺功能正常的参与者相比，SHyper女性的舒张压较低（调整后平均差[aMD] -1.3 mmHg，95%CI -2.0至 -0.5），与甲状腺功能正常的参与者相比，SHyper男性的收缩压较低（aMD -3.1 mmHg，95%CI -4.8至 -1.4）。在女性和男性中，无论甲状腺状态如何，血脂水平（总胆固醇、高密度脂蛋白、低密度脂蛋白胆固醇、甘油三酯）和hs-CRP都相似。唯一的例外是SHyper女性与甲状腺功能正常者相比，低密度脂蛋白胆固醇较低（aMD -0.17 mmol/L，95%CI -0.29至 -0.05）。
ScTD参与者和甲状腺功能正常的参与者具有相似的cvRFs，差异可能太小，无法解释先前研究中观察到的ScTD中心血管风险增加的现象。
