J Korean Endocr Soc.  2006 Dec;21(6):490-496.

Comparison of Common Carotid Artery Intima-Media Thickness between Subclinical Hypothyroidism and Euthyroidism

• Park KS
• Rue JI
• Kim SK
• Kim IJ
• Lim SW
• Park SW
• Kim YL
• Cha DH
• Cho YW
• Choi YK
• Lee SJ

Abstract

BACKGROUND: Common carotid artery intima-media thickness (IMT), which is increased in patients with overt hypothyroidism, is an independent risk factor of the atherosclerosis-related disease. This study was performed to compare serum lipid level and common carotid artery IMT among patients with overt hypothyroidism, subclinical hypothyroidism and euthyroidism.
METHODS
Patients with newly-diagnosed subclinical (n=32) and overt (n=32) hypothyroidism were selected for this study. All of the patients and an age- and sex-matched euthyroidism cohort were checked for clinical characteristics and serum lipid levels. Common carotid artery IMT was also measured using high resolution B-mode ultrasonography.
RESULTS
Statistically significant differences were observed between the total cholesterol levels of patients with subclinical hypothyroidism and those with euthyroidism. When common carotid artery IMT measured by ultrasonography, subclinical (0.67 +/- 0.11 mm) and overt (0.71 +/- 0.12 mm)) hypothyroidism showed significantly increased mean IMT compared to that of euthyroidism (0.58 +/- 0.07 mm, P < 0.05, respectively), but no differences were found between subclinical and overt hypothyroidism.
CONCLUSION
We concluded that subclinical hypothyroidism is related to increased common carotid artery IMT as well as dyslipidemia. Therefore, we recommend that treatment principle of subclinical hypothyroidism be established through large-scale, prospective studies performed to determine the effect of thyroid hormone replacement on the reduction of common carotid artery IMT.

Keyword

Atherosclerosis; Intima-media thickness; Subclinical hypothyroidism

MeSH Terms

Atherosclerosis
Carotid Artery, Common*
Cholesterol
Cohort Studies
Dyslipidemias
Humans
Hypothyroidism*
Risk Factors
Thyroid Gland
Ultrasonography
Cholesterol

Figure

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  Fig. 1 Common carotid artery intima-media thickness of the study population. *P < 0.05 (one-way ANOVA followed by Scheffe's post hoc test). IMTmean, mean intima-media thickness; IMTmax, maximal intima-media thickness.

Reference

1. Lee KW. Subclinical hypothyroidism. J Korean Soc Endocrinol. 1997. 12:8–10.

2. Thompson GR, Soutar AK, Spengel FA. Defects of receptor-mediated low density lipoprotein catabolism in homozygous familial hypercholesterolemia and hypothyroidism in vivo. Proc Natl Acad Sci U S A. 1981. 78:2592–2595.

3. Vanhaelst L, Neve P, Chailly P, Basteine PA. Coronary artery disease in hypothyroidism. Lancet. 1967. 2:800–802.

4. Kutty KM, Bryant DG, Farid NR. Serum lipids in hypothyroidism. J Clin Endocrinol Metab. 1978. 46:55–60.

5. Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Grimley EJ, Young E, Bird T, Smith PA. Lipid profiles and cardiovascular disease in the Wickham area with particular reference to thyroid failure. Clin Endocrinol (Oxf). 1977. 7:495–508.

6. Fowler PB, Swale J, Andrews H. Hypercholesterolemia in borderline hypothyroidism: Stage of premyxedema. Lancet. 1970. 2:488–491.

7. Hollander M, Hak AE, Koudstaal PJ, Bots ML, Grobbee DE, Hofman A, Witteman JC, Breteler MM. Comparison between measures of atherosclerosis and risk of stroke: the Rotterdam study. Stroke. 2003. 34:2367–2372.

8. Nagasaki T, Inaba M, Henmi Y, Kumeda Y, Ueda M, Tahara H, Sugiguchi S, Fujiwara S, Emoto M, Ishimura E, Onoda N, Ishikawa T, Nishizawa Y. Decrease in carotid intima-media thickness in hypothyroid patients after normalization of thyroid function. Clin Endocrinol (Oxf). 2003. 59:607–612.

9. Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall: A direct measurement with ultrasound imaging. Circulation. 1986. 74:1399–1406.

10. Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kajimoto Y, Morishima T, Kamada T. Atherosclerosis in carotid artery of young IDDM patients monitored by ultrasound high-resolution B-mode imaging. Diabetes. 1994. 43:634–649.

11. Yamasaki Y, Kawamori R, Matsushima H, Nishizawa H, Kodama M, Kubota M, Kajimoto Y, Kamada T. A symptomatic hyperglycemia is associated with increased intimal plus medial thickness of the carotid artery. Diabetologia. 1995. 38:585–591.

12. Avriam M, Luboshitaky R, Brook JG. Lipid and lipoprotein pattern in thyroid dysfunction and the effect of therapy. Clin Biochem. 1982. 15:62–66.

13. Valdemarsson S, Hansson P, Hender P, Nilsson-Ehle P. Relations between thyroid function, hepatic and lipoprotein lipase activities, and plasma lipoprotein concentrations. Acta Endocrinol. 1983. 104:50–56.

14. Muls E, Rosseneu M, Blaton V, Lesaffre E, Lamberigts G, de Moor P. Serum lipids and apolipoproteins A-I, A-II and B in primary hypothyroidism before and during treatment. Eur J Clin Invest. 1984. 14:12–15.

15. Scottolini AG, Bhagavan NV, Oshiro TH, Abe SY. Serum high-density lipoprotein cholesterol concentration in hypo- and hyperthyroidism. Clin Chem. 1980. 26:584–587.

16. Verdugo C, Perrot L, Ponsin G, Valentin C, Berthezene F. Time-course of alterations of high density lipoproteins (HDL) during thyroxine administration to hypothyroid woman. Eur J Clin Invest. 1987. 17:313–316.

17. Agdeppa D, Macaron C, Mallik T, Cghnuda ND. Plasma high density lipoprotein cholesterol in thyroid disease. J Clin Endocrinol Metabol. 1979. 49:726–729.

18. Feely J, Iqbai SJ, Isles TE, Bakry M. Total cholesterol/HDL cholesterol ratio in hyperthyroidism, hypothyroidism, and subclinical hypothyroidism. Horm Metab Res. 1980. 12:560–561.

19. Shong YK, Ryu JS, Lee KU, Kim GS, Lee M. Serum lipids and apolipoproteins in subclinical and overt hypothyroidism and their changes with thyroxine therapy. J Kor Soc Endocrinol. 1992. 7:31–38.

20. Kim KA, Chung JH, Kim YS, Ahn KJ, Koh EM, Min YK, Lee MS, Lee MK, Lee JH, Kim KW. Serum lipoprotein(a) and lipid concentrations in patients with subclinical hypothyroidism. J Kor Soc Endocrinol. 1997. 12:11–17.

21. Jie JC, Chau T, Teri AM, Bruce MP, Lewis HK, Paulo HMC, Joseph FP, Kim ST, David MH, Thomas RP, Mary C. C-reactive protein, carotid intima-media thickness, and incidence of ischemic stroke in the elderly. Circulation. 2003. 108:166–170.

22. Monzani F, Caraccio N, Kozakowa M, Dardano A, Vittone F, Virdis A, Taddei S, Palombo C, Ferrannini E. Effect of levethyroxine replacementon lipid profile and intima-media thickness in subclinical hypothyroidism: A double-blind, placebo-controlled study. J Clin Endocrinol Metab. 2004. 89:2099–2106.

23. John PW, Alexandra PB, Max KB, Peter O, Peter JL, Peter F, Valdo M. Subclinical thyroid dysfunction as a risk factor for cardiovascular disease. Arch Intern Med. 2005. 165:2467–2472.

24. Nicolas R, Anne BN, Eric V, Nathalie R, Suzanne S, Tamara BH, Douglas CB. Subclinical hypothyroidism and the risk of heart failure, other cardiovascular events, and death. Arch Intern Med. 2005. 165:2460–2466.

25. Baran DT. Detrimental skeletal effects of thyrotropin suppressive doses of thyroxine: fact or fantasy? J Clin Endocrinol Metab. 1994. 78:816–817.

26. Sawin CT, Geller A, Wolf PA, Belanger AJ, Baker E, Bacharach P, Wilson PW, Benjamin EJ, D'Agostino RB. Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons. N Engl J Med. 1994. 331:1249–1252.

27. Kim WB, Cho BY, Park GS, Park HK, Kim SK, Park HY, Shin CS, Kim SY, Lee HK, Koh CS. Changes on serum lipids and apolipoproteins levels according to the thyroxine treatment in the patients with subclinical hypothyroidism. J Kor Soc Endocrinol. 1996. 11:41–51.