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Aortic stiffness and left ventricular function in patients with differentiated thyroid cancer

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Abstract

Objective

The aim of this study was to investigate aortic stiffness and left ventricular (LV) systolic and diastolic function in patients with differentiated thyroid cancer (DTC) on thyroxine (L-T4) therapy and after L-T4 withdrawal to assess the cardiovascular impact of long-term subclinical hyperthyroidism and short-term overt hypothyroidism.

Methods

Twenty-four patients who had had total thyroidectomy and radioiodine ablation for differentiated thyroid cancer were studied on two occasions: on TSH suppressive L-T4 therapy (sTSH 0.24 ± 0.11 mU/L), and 4 weeks after L-T4 withdrawal (sTSH 89.82 ± 29.36 mU/L). Echocardiography was performed and thyroid function, serum thyroglobulin, lipid parameters, homocystine, C-reactive protein, fibrinogen and von Willebrand factor activity (vWF) were measured. Twenty-two healthy volunteers matched for age and sex served as euthyroid controls.

Results

Aortic stiffness was increased both in hypothyroidism (6.04 ± 2.88 cm2/dyn/103, p < 0.05) and subclinical hyperthyroidism (9.27 ± 4.81 cm2/dyn/103, p < 0.05) vs. controls (3.92 ± 1.84 cm2/dyn/103). Subclinical hyperthyroidism had a more marked effect (p < 0.05). LV dimensions and ejection fractions were similar before and after L-T4 withdrawal. The E′/A′ was higher in euthyroid controls (1.34 ± 1.02) as compared to both subclinical hyperthyroidism (1.0 ± 0.14, p < 0.05) and overt hypothyroidism (1.13 ± 0.98, p < 0.05). Change of aortic stiffness correlated with change of free-thyroxine (fT4), vWF and fibrinogen levels in a positive manner.

Conclusion

Long-term thyrotropin-suppression therapy has continuous adverse effects on the arterial wall. The degree of TSH suppression in patients with DTC should be kept at the possible minimum, based on individually determined potential benefits and risks of treatment, especially in patients with cardiovascular co-morbidities.

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Acknowledgments

This research was supported by the European Union and the State of Hungary, co-financed by the European Social Fund in the framework of TÁMOP-4.2.4.A/2-11/1-2012-0001 ‘National Excellence Program’. The infrastructure of this work was supported by the TÁMOP-4.2.2.A-11/1/KONV-2012-0031 project and the Hungarian Scientific Research Fund (Grant number OTKA K105733).

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The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, P.O.B. 19, Debrecen, 4012, Hungary

    A. Gazdag, E. V. Nagy, A. Erdei, M. Bodor, E. Berta, Z. Szabó & Z. Jenei

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  1. A. Gazdag
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  2. E. V. Nagy
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  3. A. Erdei
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  4. M. Bodor
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Correspondence to A. Gazdag.

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Gazdag, A., Nagy, E.V., Erdei, A. et al. Aortic stiffness and left ventricular function in patients with differentiated thyroid cancer. J Endocrinol Invest 38, 133–142 (2015). https://doi.org/10.1007/s40618-014-0143-0

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