The beneficial effect of L-thyroxine on cardiovascular risk factors

[Dobro]

The beneficial effect of L-thyroxine on cardiovascular risk factors, endothelial function and quality of life in subclinical hypothyroidism: randomised, crossover trial
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Context: Subclinical hypothyroidism (SCH) is defined as raised serum thyrotropin (TSH) levels with circulating thyroid hormones within the reference range. It is uncertain whether treatment of SCH with L-thyroxine improves cardiovascular (CV) risk factors and quality of life (QoL).

Objective: To assess CV risk factors and patient-reported outcomes after treatment.

Design: Randomised double-blind crossover study of L-thyroxine and placebo.

Setting: Community-dwelling patients.

Patients: One hundred patients [mean age (SD) 53.8 (12) years, 81 females] with SCH [mean TSH 6.6 (1.3) mIU/L] without previously treated thyroid or vascular disease.

Intervention: 100 µg of L-thyroxine or placebo daily for twelve weeks each.

Measurements: Primary parameters were total cholesterol (TC) and endothelial function [brachial artery flow-mediated dilatation (FMD)], an early marker of atherosclerosis. Patient-reported outcomes were also assessed.

Results: L-thyroxine treatment reduced TC (versus placebo) from 231.6 to 220 mg/dL, p<0.001; LDL cholesterol from 142.9 to 131.3 mg/dL, p<0.05; waist-hip ratio from 0.83 to 0.81, p<0.006; and improved FMD from 4.2 to 5.9%, p<0.001. Multivariate analysis showed that increased serum free thyroxine (FT4) level was the most significant variable predicting reduction in TC or improvement in FMD. Furthermore, the symptom of tiredness improved on L-thyroxine therapy but other patient-reported outcomes were not significantly different, after correction for multiple comparisons.

Conclusion: SCH treated by L-thyroxine leads to a significant improvement in CV risk factors and symptoms of tiredness. The CV risk factor reduction is related to the increased level of achieved FT4 concentration.

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[Melnichenko]

Спасибо ,это одна из многих статей, доказывающих ПОЛЬЗУ тироксина при субклиничсеком гипотиирозе по сурогатным маркерам, в опредленной возрастной группе- справедливости ради заметим, что по эпидемиологические исследования в группе 80+ , напротив, доказывают преимущества СГ нелеченного. Словом, это горячая точка нашей медицины и эндокринологии- но твердых доказательства за и против пока не набралось достаточно ( да простит меня Koutras )