Document Detail

Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy.
MedLine Citation:
PMID:  19906785     Owner:  NLM     Status:  MEDLINE    
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.
Robert W Flynn; Sandra R Bonellie; Roland T Jung; Thomas M MacDonald; Andrew D Morris; Graham P Leese
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-11-11
Journal Detail:
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:
Created Date:  2010-01-08     Completed Date:  2010-02-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375362     Medline TA:  J Clin Endocrinol Metab     Country:  United States    
Other Details:
Languages:  eng     Pagination:  186-93     Citation Subset:  AIM; IM    
Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom.
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MeSH Terms
Aged, 80 and over
Cardiovascular Diseases / blood,  epidemiology*
Fractures, Bone / blood,  epidemiology*,  etiology
Hormone Replacement Therapy / adverse effects
Hypothyroidism / blood,  drug therapy*,  epidemiology
Middle Aged
Osmolar Concentration
Osteoporosis / blood,  complications,  epidemiology
Thyrotropin / blood*
Thyroxine / adverse effects,  therapeutic use*
Time Factors
Young Adult
Reg. No./Substance:
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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