Features of the relationship between thyroid-stimulating hormone values and some markers of cardiovascular risk in subclinical hypothyroidism


  • N.V. Pasiechko MD, PhD, Professor, Head of the Department of internal medicine 1, I. Horbachevskyi Ternopil National Medical University, Ternopil, Ukraine; e-mail: pasyechkonv@gmail.com http://orcid.org/0000-0002-2081-4269
  • Yu.V. Yevstratieva post-graduate student of the Department of Internal Medicine 1, State Institution of Higher Education “I. Horbachevsky Ternopil National Medical University”, Maidan Voli, 1, Ternopil, 46001, Ukraine; e-mail: dr.yevstratieva@gmail.com http://orcid.org/0000-0001-7227-9870




subclinical hypothyroidism, thyroid-stimulating hormone, ROC analysis, cardiovascular disorders


Background. Hypothyroidism, including subclinical one, is associated with an increased risk of chronic heart failure. According to the Cardiovascular Health Study, an increased level of thyroid­stimulating hormone (TSH) can be considered as a risk factor for heart failure. The purpose of the study was to investigate the relationship between TSH levels and the presence of cardiovascular disorders in female patients with subclinical hypothyroidism. Materials and me­thods. Twenty­six women of reproductive age (32 to 47 years old) with subclinical hypothyroidism (group 1) and 25 women without a history of thyroid dysfunction and cardiac pathology (group 2) were included in a cross­sectional study. In all patients, the presence of factors and markers of cardiovascular risk, early signs of myocardial damage were evaluated. To compare groups of patients with normal thyroid function and with subclinical hypothyroidism (groups 1 and 2), the receiver operating characteristic (ROC) analysis was used to identify the TSH levels associated with the highest likelihood of detecting abnormalities. Results. According to the ROC analysis, TSH level ≥ 4.67 mIU/l predicted the development of diastolic dysfunction of the left and/or right ventricle with sensitivity of 70.6 (49.8; 89.1) % and specificity of 69.3 (53.2; 80.6) % (area under the ROC curve (AUC) 0.672 (0.561; 0.787); p = 0.032). Similarly, TSH value of ≥ 4.8 mIU/l indicated the possibility of detecting segmental relaxation disorders with sensitivity of 61.9 (46.2; 77.7) % and specificity of 73.1 (42.9; 91.0) % (AUC 0.680 (0.543; 0.831); p = 0.042). Conclusions. Initial manifestations of cardiovascular disorders more often occur with TSH values in the range of 4.6–5.9 mIU/l. TSH level of more than 5.45 mIU/l can be considered as a predictor of the development of cardiovascular disorders associated with subclinical hypothyroidism.


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Iacoviello M, Guida P, Guastamacchia E, et al. Prognostic role of sub-clinical hypothyroidism in chronic heart failure outpatients. Curr Pharm Des. 2008;14(26):2686-92. doi: 10.2174/138161208786264142.

Biondi B, Cappola AR, Cooper DS. Subclinical Hypothyroidism: A Review. JAMA. 2019 Jul 9;322(2):153-160. doi: 10.1001/jama.2019.9052.

Ozmen B, Ozmen D, Parildar Z, Mutaf I, Bayindir O. Serum N-terminal-pro-B-type natriuretic peptide (NT-pro-BNP) levels in hyperthyroidism and hypothyroidism. Endocr Res. 2007;32(1-2):1-8. doi: 10.1080/07435800701670047.

Biondi B. Natural history, diagnosis and management of subclinical thyroid dysfunction. Best Pract Res Clin Endocrinol Metab. 2012 Aug;26(4):431-46. doi: 10.1016/j.beem.2011.12.004.

Brenta G, Vaisman M, Sgarbi JA, et al. Clinical practice guidelines for the management of hypothyroidism. Arq Bras Endocrinol Metabol. 2013 Jun;57(4):265-91. doi: 10.1590/s0004-27302013000400003.

Cooper DS, Biondi B. Subclinical thyroid disease. Lancet. 2012 Mar 24;379(9821):1142-54. doi: 10.1016/S0140-6736(11)60276-6.

Duntas LH, Wartofsky L. Cardiovascular risk and subclinical hypothyroidism: focus on lipids and new emerging risk factors. What is the evidence? Thyroid. 2007 Nov;17(11):1075-84. doi: 10.1089/thy.2007.0116.

Rodondi N, den Elzen WP, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010 Sep 22;304(12):1365-74. doi: 10.1001/jama.2010.1361.

Sviridonova MA, Fadeyev VV, Sych YP, Melnichenko GA. Clinical significance of TSH circadian variability in patients with hypothyroidism. Endocr Res. 2013;38(1):24-31. doi: 10.3109/07435800.2012.710696.

Garber JR, Cobin RH, Gharib H, et al. Clinical Practice Guidelines for Hypothyroidism in Adults: Co-sponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Endocr Pract. 2012 Nov-Dec;18(6):988-1028. doi: 10.4158/EP12280.GL.

Mariotti S, Zoncu S, Pigliaru F, et al. Cardiac effects of L-thyroxine administration in borderline hypothyroidism. Int J Cardiol. 2008 May 23;126(2):190-5. doi: 10.1016/j.ijcard.2007.03.130.

Pearce SH, Brabant G, Duntas LH, et al. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013 Dec;2(4):215-28. doi: 10.1159/000356507.

Razvi S, Weaver JU, Butler TJ, Pearce SH. Levothyroxine treatment of subclinical hypothyroidism, fatal and nonfatal cardiovascular events, and mortality. Arch Intern Med. 2012 May 28;172(10):811-7. doi: 10.1001/archinternmed.2012.1159.

Hilgers RA. Distribution-free confidence bounds for ROC curves. Methods Inf Med. 1991 Apr;30(2):96-101.

Virgini V, Collet TH, Christ E, Aujesky D, Rodondi N. Should we screen and treat subclinical hypothyroidism? Rev Med Suisse. 2012 Mar 7;8(331):501-2, 504-6. (in French).

Weiss IA, Bloomgarden N, Frishman WH. Subclinical hypothyroidism and cardiovascular risk: recommendations for treatment. Cardiol Rev. 2011 Nov-Dec;19(6):291-9. doi: 10.1097/CRD.0b013e318227df87.



How to Cite

Pasiechko, N., & Yevstratieva, Y. (2021). Features of the relationship between thyroid-stimulating hormone values and some markers of cardiovascular risk in subclinical hypothyroidism. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), 15(8), 633–638. https://doi.org/10.22141/2224-0721.15.8.2019.191687



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