Serum thyroid-stimulating hormone concentration and morbidity from cardiovascular disease and fractures in patients on long-term thyroxine therapy

For patients on T(4) replacement, the dose is guided by serum TSH concentrations, but some patients request higher doses due to adverse symptoms. 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. We condu...

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Veröffentlicht in:The journal of clinical endocrinology and metabolism Jg. 95; H. 1; S. 186
Hauptverfasser: Flynn, Robert W, Bonellie, Sandra R, Jung, Roland T, MacDonald, Thomas M, Morris, Andrew D, Leese, Graham P
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.01.2010
Schlagworte:
Adolescent
Adult
Aged
Aged, 80 and over
Cardiovascular Diseases - blood
Cardiovascular Diseases - epidemiology
Comorbidity
Female
Fractures, Bone - blood
Fractures, Bone - epidemiology
Fractures, Bone - etiology
Hormone Replacement Therapy - adverse effects
Humans
Hypothyroidism - blood
Hypothyroidism - drug therapy
Hypothyroidism - epidemiology
Male
Middle Aged
Osmolar Concentration
Osteoporosis - blood
Osteoporosis - complications
Osteoporosis - epidemiology
Thyrotropin - blood
Thyroxine - adverse effects
Thyroxine - therapeutic use
Time Factors
Young Adult
ISSN:1945-7197, 1945-7197
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Zusammenfassung:For patients on T(4) replacement, the dose is guided by serum TSH concentrations, but some patients request higher doses due to adverse symptoms. 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. We conducted an observational cohort study, using data linkage from regional datasets between 1993 and 2001. A population-based study of all patients in Tayside, Scotland, was performed. All patients taking T(4) replacement therapy (n = 17,684) were included. 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). 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]. 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.
Bibliographie:ObjectType-Article-2
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ObjectType-Undefined-1
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ISSN:1945-7197
1945-7197
DOI:10.1210/jc.2009-1625