Yonsei Med J.  2010 Jul;51(4):492-498. 10.3349/ymj.2010.51.4.492.

Endothelial Function is Not Changed during Short-Term Withdrawal of Thyroxine in Patients with Differentiated Thyroid Cancer and Low Cardiovascular Risk

• Chang HJ
• Kim KW
• Choi SH
• Lim S
• Park KU
• Park DJ
• Choi DJ
• Jang HC
• Cho BY
• Park YJ

• KMID: 1805184
• DOI: http://doi.org/10.3349/ymj.2010.51.4.492

Abstract

PURPOSE
The incidence of differentiated thyroid cancer is increasing in young adults and females in Korea. Some of them experience short-term hypothyroidism in preparation for radioiodine (RAI) therapy, which can have a deleterious effect on the cardiovascular system. However, it is not clear if short-term hypothyroidism induces endothelial dysfunction in patients with low cardiovascular risk. Therefore, the aim of this study was to investigate whether short-term hypothyroidism is associated with endothelial dysfunction in patients with low cardiovascular risk.
MATERIALS AND METHODS
To evaluate the effect of short-term hypothyroidism on endothelial function in this group, we recruited fifteen female patients with low cardiovascular risk. We analyzed clinical, biochemical, and cardiovascular parameters at four time points: the last day on levothyroxine (LT4) at their usual thyroid-stimulating hormone (TSH)-suppressive doses (P1), 7 days (P2) & 4 weeks (P3) after withdrawal of LT4, and 8 weeks (P4) after replacement of the previous dose of LT4. A high resolution ultrasound was used to measure brachial artery diameter at rest, after reactive hyperemia, and after sublingual nitroglycerin.
RESULTS
During short-term hypothyroidism (P3), serum concentrations of total cholesterol and low-density lipoprotein (LDL)-cholesterol were increased (p < 0.001 for each period). In spite of having worsened lipid states, serum high sensitivity C-reactive protein or flow-mediated vasodilatation, which is one of the surrogate markers of the endothelial function, did not change during short-term hypothyroidism.
CONCLUSION
Short-term hypothyroidism induced worsening of metabolic parameters, but not enough to induce the endothelial dysfunction in patients with low cardiovascular risk.

Keyword

Short-term hypothyroidism; endothelial dysfunction; thyroid cancer; radioactive iodine; flow-mediated vasodilatation

Figure

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  Fig. 1 Effect of thyroid dysfunction on endothelial function. (A) Flow-mediated arterial dilatation (FMD) (endothelin-dependent vasodilatation) and (B) nitroglycerin-mediated dilatation (NMD) (endothelin-independent vasodilatation) was measured at each of the four stages (P1, 2, 3, 4). Differences between continuous variables before and after treatment were compared by means of repeated measures ANOVA. Median values, interqurtile ranges, and ranges are denoted by horizontal bars, boxes, and error bars.

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