| Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy. | |
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MedLine Citation:
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PMID: 19906785 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: For patients on T(4) replacement, the dose is guided by serum TSH concentrations, but some patients request higher doses due to adverse symptoms. OBJECTIVE: The aim of the study was to determine the safety of patients having a low but not suppressed serum TSH when receiving long-term T(4) replacement. DESIGN: We conducted an observational cohort study, using data linkage from regional datasets between 1993 and 2001. SETTING: A population-based study of all patients in Tayside, Scotland, was performed. PATIENTS: All patients taking T(4) replacement therapy (n = 17,684) were included. MAIN OUTCOME MEASURES: Fatal and nonfatal endpoints were considered for cardiovascular disease, dysrhythmias, and fractures. Patients were categorized as having a suppressed TSH (<or=0.03 mU/liter), low TSH (0.04-0.4 mU/liter), normal TSH (0.4-4.0 mU/liter), or raised TSH (>4.0 mU/liter). RESULTS: Cardiovascular disease, dysrhythmias, and fractures were increased in patients with a high TSH: adjusted hazards ratio, 1.95 (1.73-2.21), 1.80 (1.33-2.44), and 1.83 (1.41-2.37), respectively; and patients with a suppressed TSH: 1.37 (1.17-1.60), 1.6 (1.10-2.33), and 2.02 (1.55-2.62), respectively, when compared to patients with a TSH in the laboratory reference range. Patients with a low TSH did not have an increased risk of any of these outcomes [hazards ratio: 1.1 (0.99-1.123), 1.13 (0.88-1.47), and 1.13 (0.92-1.39), respectively]. CONCLUSIONS: Patients with a high or suppressed TSH had an increased risk of cardiovascular disease, dysrhythmias, and fractures, but patients with a low but unsuppressed TSH did not. It may be safe for patients treated with T(4) to have a low but not suppressed serum TSH concentration. |
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Authors:
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Robert W Flynn; Sandra R Bonellie; Roland T Jung; Thomas M MacDonald; Andrew D Morris; Graham P Leese |
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Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't Date: 2009-11-11 |
Journal Detail:
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Title: The Journal of clinical endocrinology and metabolism Volume: 95 ISSN: 1945-7197 ISO Abbreviation: J. Clin. Endocrinol. Metab. Publication Date: 2010 Jan |
Date Detail:
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Created Date: 2010-01-08 Completed Date: 2010-02-01 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0375362 Medline TA: J Clin Endocrinol Metab Country: United States |
Other Details:
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Languages: eng Pagination: 186-93 Citation Subset: AIM; IM |
Affiliation:
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Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Cardiovascular Diseases / blood, epidemiology* Comorbidity Female Fractures, Bone / blood, epidemiology*, etiology Hormone Replacement Therapy / adverse effects Humans Hypothyroidism / blood, drug therapy*, epidemiology Male Middle Aged Osmolar Concentration Osteoporosis / blood, complications, epidemiology Thyrotropin / blood* Thyroxine / adverse effects, therapeutic use* Time Factors Young Adult |
| Chemical | |
Reg. No./Substance:
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7488-70-2/Thyroxine; 9002-71-5/Thyrotropin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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