woensdag 23 mei 2012

Schildklier en hart - aandacht voor twee onderzoeken

Schildklieraandoeningen komen vaak voor. Of het nu gaat om hypothyreoïdie, hyperthyreoïdie, de oogziekte of schildklierkanker. Vreemd is dat er relatief weinig aandacht voor de schildklier is.

Schildklier en hart

Een schildklier die te veel of te weinig hormoon maakt, kan voor problemen zorgen. Vraag is: wat te doen? Veel is nog onbekend. Hieronder vind je aandacht voor de combinatie schildklier en hart. Wil je er nog meer over weten? Zoek dan met het woord hart met de zoekknop (zie rechtsboven).

Subklinische hyperthyreoïde en het hart

Subclinical hyperthyroidism, defined by low thyrotropin (TSH) level with normal concentrations of free thyroxine (FT4) and triiodothyronine (T3) has been associated with several biological effects on the cardiovascular system, such as increased heart rate, left ventricular mass, carotid intima-media thickness, and plasma fibrinogen levels. Observational studies have reported an association between subclinical hyperthyroidism and coronary heart disease (CHD), incident atrial fibrillation (AF), and cardiac dysfunction.

Subclinical hyperthyroidism and the risk of coronary heart disease and mortality
Collet TH, Gussekloo J, Bauer DC, et al.

Results from prospective cohort studies are conflicting, and study-level meta-analyses have reached contradictory conclusions, for example, regarding the association between subclinical hyperthyroidism and cardiovascular mortality. In fact, interpretation of these studies is hampered by several methodological factors: population heterogeneity, different thyrotropin cutoff levels for subclinical hyperthyroidism definition, different use of covariates, and different CHD definitions.

Although no large randomized controlled trials have examined the effects of treating subclinical hyperthyroidism on clinically relevant outcomes, a consensus statement and recent guidelines advocate treatment of subclinical hyperthyroidism, particularly when thyrotropin (TSH) level is lower than 0.10 mIU/L, to avoid long-term complications.

Subklinische hypothyreoïdie en het hart

Subclinical hypothyroidism is associated with an increased risk of heart disease CHD events and CHD mortality in those with higher TSH levels, particularly in those with a TSH concentration of 10 mIU/L or greater.

Subclinical hypothyroidism and the risk of coronary heart disease and mortality
Nicolas Rodondi, Wendy den Elzen, Jacobijn Gussekloo et al.

Controversy persists on the indications for screening and threshold levels of thyroid-stimulating hormone (TSH) for treatment of subclinical hypothyroidism, defined as elevated serum TSH levels with normal thyroxine (T4) concentrations. Because subclinical hypothyroidism has been associated with hypercholesterolemia and atherosclerosis, screening and treatment have been advocated to prevent cardiovascular disease. However, data on the associations with coronary heart disease (CHD) events and mortality are conflicting among several large prospective cohorts.

Three recent study-level meta-analyses found modestly increased risks for CHD and mortality, but with heterogeneity among individual studies that used different TSH cutoffs, different confounding factors for adjustment, and varying CHD definitions. Part of the heterogeneity might also be related to differences in participants' age, sex, or severity of subclinical hypothyroidism (as measured by TSH level).

One cohort study suggested particularly high risk in participants with subclinical hypothyroidism and preexisting cardiovascular disease.

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