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Subclinical Hypothyroidism in Grown-Up Congenital Heart Disease Patients

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Abstract

Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34–5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296–17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963–19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000–1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.

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Authors and Affiliations

  1. Servicio de Cardiología, Complejo Hospitalario Universitario Insular-Materno Infantil, Avda. Marítima del Sur s/n, 35016, Las Palmas, Spain

    Efrén Martínez-Quintana & Vicente Nieto-Lago

  2. Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain

    Fayna Rodríguez-González

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  1. Efrén Martínez-Quintana
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  2. Fayna Rodríguez-González
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  3. Vicente Nieto-Lago
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Correspondence to Efrén Martínez-Quintana.

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Martínez-Quintana, E., Rodríguez-González, F. & Nieto-Lago, V. Subclinical Hypothyroidism in Grown-Up Congenital Heart Disease Patients. Pediatr Cardiol 34, 912–917 (2013). https://doi.org/10.1007/s00246-012-0571-6

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  • DOI: https://doi.org/10.1007/s00246-012-0571-6

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