scholarly journals Long-Term Cardiovascular Effects of Levothyroxine Therapy in Young Adults with Congenital Hypothyroidism

2008 ◽  
Vol 93 (7) ◽  
pp. 2486-2491 ◽  
Author(s):  
Mariacarolina Salerno ◽  
Ugo Oliviero ◽  
Teresa Lettiero ◽  
Vincenzo Guardasole ◽  
Dario Maria Mattiacci ◽  
...  
Keyword(s):  
Young Adults ◽  
Replacement Therapy ◽  
Exercise Capacity ◽  
Congenital Hypothyroidism ◽  
Intima Media Thickness ◽  
Normal Range ◽  
Levothyroxine Replacement ◽  
Levothyroxine Treatment ◽  
Tsh Levels

Abstract Context: Congenital hypothyroidism (CH) is the most prevalent endocrine disorder in the newborn and is routinely treated with life-long levothyroxine replacement therapy. Although several studies have demonstrated that such therapy may impact on the cardiovascular system, little is known with regard to the effects of long-term levothyroxine administration in patients with CH. Objective: The aim of the current study was to evaluate whether long-term levothyroxine replacement therapy in young adults with CH is associated with cardiovascular abnormalities. Patients and Methods: Thirty young adults with CH aged 18.1 ± 0.2 yr and 30 age- and sex-matched controls underwent cardiac and carotid Doppler ultrasound and symptom-limited cardiopulmonary exercise testing. Hypothyroidism was diagnosed by neonatal screening, and levothyroxine treatment was initiated within the first month of life and carefully adjusted to maintain TSH levels in the normal range and free T4 in the high-normal range. Results: Compared with controls, hypothyroid patients exhibited left ventricular diastolic dysfunction, impaired exercise capacity, and increased intima-media thickness. At multiple regression analysis, the number of episodes of plasma TSH levels less than 0.5 mU/liter and greater than 4.0 mU/liter from the age of 1 yr onward, and mean TSH plasma levels during puberty were independent predictors of diastolic filling and cardiopulmonary performance indexes (multiple r values: 0.61–0.75). Conclusions: Long-term levothyroxine treatment in young adults with congenital hypothyroidism is associated with impaired diastolic function and exercise capacity and increased intima-media thickness.

scholarly journals Effects of long-term l-thyroxine treatment on endothelial function and arterial distensibility in young adults with congenital hypothyroidism

2010 ◽  
Vol 162 (2) ◽  
pp. 289-294 ◽  
Author(s):  
Ugo Oliviero ◽  
Antonio Cittadini ◽  
Giorgio Bosso ◽  
Manuela Cerbone ◽  
Antonio Valvano ◽  
...  
Keyword(s):  
Young Adults ◽  
Endothelial Function ◽  
Replacement Therapy ◽  
Congenital Hypothyroidism ◽  
Brachial Artery ◽  
Linear Regression Analysis ◽  
Arterial Distensibility ◽  
Significant Impairment ◽  
Tsh Levels

ObjectivePatients with congenital hypothyroidism (CH) display subclinical abnormalities of the cardiovascular system that are related to unphysiological fluctuations of TSH levels and occur despite careful replacement therapy.DesignThe aim of the present case–control study was to evaluate the effects of long-term levothyroxine (l-T4) replacement therapy on the vascular district in CH patients by assessing endothelial function with flow-mediated dilation (FMD) and brachial artery distensibility with the measurement of the coefficient of distensibility (DC).MethodsThirty-two young adults with CH aged 18.9±0.2 years and 32 age- and sex-matched controls underwent brachial Doppler ultrasound examination to measure FMD and DC at the time of the study. Hypothyroidism was diagnosed by neonatal screening, and l-T4 treatment was initiated within the first month of life.ResultsCompared to healthy controls, CH patients had significantly reduced brachial artery reactivity with lower FMD values (8.9±5.7 vs 14.1±5.1% P=0.003) and decreased vascular distensibility (24.6±1.6 vs 27.3±3 kPa−1×10−3, P<0.0002). Linear regression analysis revealed that both total and pubertal mean TSH and number of episodes of undertreatment were independent determinants of FMD and DC. Pubertal mean TSH was the best predictor of both FMD and DC (r=0.81 and r=0.87 respectively, P<0.001).ConclusionsYoung adults with CH treated with long-term l-T4 replacement therapy may have significant impairment of both FMD and DC. Our data suggest that high TSH levels, inadequately corrected by l-T4 replacement therapy in CH patients especially during puberty, can exert significant effects on the elastic and functional vessel properties.

scholarly journals Serum lipids in hypothyroid children: effect of disease and levothyroxine replacement therapy

2002 ◽  
Vol 21 (4) ◽  
pp. 331-338 ◽  
Author(s):  
Vesna Radonjic ◽  
Zorana Jelic-ivanovic ◽  
Slavica Spasic ◽  
Natasa Bogavac-Stanojevic ◽  
Vesna Spasojevic-Kalimanovska ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Serum Lipids ◽  
Age Groups ◽  
Lipid Lowering ◽  
Healthy Children ◽  
Healthy Controls ◽  
Serum Samples ◽  
Increased Risk ◽  
Levothyroxine Replacement

Hypothyroidism is associated with dislipidaemia and an increased risk of atherosclerosis. The aim of this study was to examine the effect of disease and long-term levothyroxine replacement therapy on serum lipids in hypothyroid children. We measured concentrations of total cholesterol, HDL-cholesterol LDL-cholesterol, triglycerides and thyroid-stimulating hormone in serum samples of 58 children with hypothyroidism (before and after therapy) and in 100 healthy controls. LDL-C and TC values were most markedly affected by the hypothyroid state. The values in the patients were on the average of 100% (LDL-C) and 54% (TC) higher than in the healthy controls. This finding is accordance with the known fact that LDL clearance is slower in hypothyroidism. TG concentrations were slightly higher (p<0.05) and HDL-C lower (p<0.02), but only in some age groups of patients. The effect of long-term L-T4 replacement on LDL-C and TC was quantitatively most pronounced. The values obtained in patients after therapy were markedly lower than before therapy and did not differ significantly from the values found in the corresponding age groups of healthy children. Significantly lower concentrations of HDL-C and TG after L-T4 administration were found only in children aged from 10 to 15 years. When we compared the lipid-lowering effect of L-T4 replacement therapy in normometabolic versus hypometabolic patients, we obtained a significantly greater effect on TC and LDL-C values in the normometabolic than in hypometabolic group (p<0.01). TC and LDL-C concentrations obtained in the L-T4 treated patients correlated well with the corresponding TSH levels (r = 0.770 and 0.725, respectively).

Beneficial effects of GH replacement therapy in adults

1991 ◽  
Vol 125 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Jens Sandahl Christiansen ◽  
Jens Otto Lunde Jørgensen
Keyword(s):  
Body Composition ◽  
Muscle Strength ◽  
Replacement Therapy ◽  
Kidney Function ◽  
Exercise Capacity ◽  
Hormone Deficiency ◽  
Gh Treatment ◽  
Beneficial Effects ◽  
Gh Replacement

Abstract. Growth hormone deficiency in adults is associated with psychosocial maladjustment, reduced muscle strength, and reduced exercise capacity. Body composition is significantly altered, with increased fat and decreased muscle volume as compared with healthy subjects. Kidney function is subnormal. Epidemiological data suggest premature mortality owing to cardiovascular disease in hypopituitary patients. Short-term GH treatment trials have shown improved psychosocial performance, normalization of body composition, increased muscle strength, improved exercise capacity, increased cardiac performance, and normalization of kidney function. Thus GH replacement therapy in GH-deficient adults exhibits potential long-term beneficial effects. A number of important questions have to be addressed before long-term GH replacement therapy in GH-deficient adults can be considered on a routine basis.

scholarly journals Long-term changes in carotid intima-media thickness among HIV-infected children and young adults

2013 ◽  
Vol 19 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Allison Ross Eckard ◽  
Mary Ann O'Riordan ◽  
Norma Storer ◽  
Grace A McComsey
Keyword(s):  
Young Adults ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness ◽  
Long Term Changes ◽  
Children And Young Adults

scholarly journals SAT-425 Characteristics of Hypothyroid Patients Achieving Long Term Euthyroidism on Levothyroxine Treatment

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Howard Tandeter ◽  
JaYanah Murad ◽  
Liad Alfandari ◽  
Victor Novack ◽  
Merav Fraenkel
Keyword(s):  
Subclinical Hypothyroidism ◽  
Thyroid Autoantibodies ◽  
Iron Supplements ◽  
Levothyroxine Replacement ◽  
Clalit Health Service ◽  
Study Population ◽  
Pre Treatment ◽  
Hypothyroid Patients ◽  
Levothyroxine Treatment

Abstract Background Studies have shown that hypothyroid patients treated with Levothyroxine replacement therapy often experience fluctuations in TSH levels, while others remain well controlled over time. Aim To assess the association between pre-treatment TSH and other biochemical and clinical characteristics and long-term maintenance of normal TSH under Levothyroxine treatment. Methods This is a retrospective nested case-control study. Study population included patients above age 18 insured by Clalit Health Service (CHS) in the South of Israel between the years 2002-2017, diagnosed with hypothyroidism (ICD 9 code 244.9) and who had at least one TSH measurement before initiating levothyroxine therapy, purchased this medication for at least 5 consecutive years with one annual TSH measurement while on treatment. Patients with surgical, post iodine ablation or congenital hypothyroidism were excluded. Patients with a TSH level within the normal range for 5 consecutive years were defined as cases while the others served as controls. Demographic, laboratory, pregnancy status and pharmacy purchase were extracted from the computerized medical records of CHS and compared between the groups. Results Out of 5472 patients included in the study, 644 had a normal TSH for 5 consecutive years (11.8%, cases). Mean age at first levothyroxine purchase was 55.8±13.7 in cases and 54.10±16.2 in controls (p=0.003) and females comprised 84.8% and 81.4% respectively (p=0.035). Mean pretreatment TSH was 5.15±9.6 in cases and 10.02±29 in controls (p&lt;0.001). Thyroid autoantibodies (anti TPO or anti thyroglobulin) were available in 40.8% and 44.8% of cases and controls respectively (P=0.63) and were positive in 36.5% and 56.7% (p&lt;0.01). Subclinical hypothyroidism was diagnosed in 44.4% of cases and 54.6% of controls with prior to treatment. The odds ratio (OR) for having normal TSH for at least 5 consecutive years, using multivariable logistic regression was 0.99 for pretreatment mean TSH (p=0.89), 0.48 for positive thyroid antibodies (p&lt;0.001), 0.72 for pretreatment diagnosis of subclinical hypothyroidism (p=0.032), 0.69 for use of iron supplements and 1.01 for age at first levothyroxine purchase (per year, p=0.02). Conclusions In our study population of adults with hypothyroidism treated with levothyroxine, only 11.8% were controlled for at least 5 consecutive years. Positive thyroid autoantibodies, pretreatment subclinical hypothyroidism and use of iron supplements lowered probability of long term TSH normalization, while age was associated with the increased rate. Further research should test whether TSH control for 5 consecutive years signals simply “good contol”, or perhaps the possibility of transient forms of hypothyroidism for which treatment discontinuation is recommended.

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