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Open Access 08-06-2024 | Hypothyroidism | IM - ORIGINAL

Subclinical hypothyroidism predicts outcome in heart failure: insights from the T.O.S.CA. registry

Authors: Mariarosaria De Luca, Roberta D’Assante, Massimo Iacoviello, Vincenzo Triggiani, Giuseppe Rengo, Alfredo De Giorgi, Giuseppe Limongelli, Daniele Masarone, Maurizio Volterrani, Antonio Mancini, Andrea Passantino, Pasquale Perrone Filardi, Angela Sciacqua, Olga Vriz, Roberto Castello, Michela Campo, Giuseppe Lisco, Pietro Amedeo Modesti, Stefania Paolillo, Toru Suzuki, Andrea Salzano, Alberto Maria Marra, Eduardo Bossone, Antonio Cittadini, T.O.S.CA. Investigators

Published in: Internal and Emergency Medicine

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Abstract

Subclinical hypothyroidism (SH), defined as increased serum thyroid-stimulating hormone (TSH) with normal free T4 (fT4) levels, is frequently observed in the general population. Prevalence ranges from 0.6% to 1.8% in the adult population, depending on age, sex, and iodine intake. Several studies reported a worse prognosis in patients with heart failure with reduced ejection fraction (HFrEF) and SH, but they considered heterogeneous populations suffering mainly from severe SH. Aim of this study was to evaluate if SH was independently associated with the occurrence of cardiovascular death considering 30 months of follow-up. 277 HFrEF patients enrolled in the prospective, multicenter, observational T.O.S.CA. (Terapia Ormonale Scompenso CArdiaco) registry, were included in this analysis. Patients were divided into two groups according to the presence of SH (serum TSH levels > 4.5 mIU/L with normal fT4 levels). Data regarding clinical status, echocardiography, and survival were analyzed. Twenty-three patients displayed SH (87% mild vs 13% severe), while 254 were euthyroid. No differences were found in terms of age, sex, HF etiology, and left ventricular ejection fraction. When compared with the euthyroid group, SH patients showed higher TSH levels (7.7 ± 4.1 vs 1.6 ± 0.9, p < 0.001), as expected, with comparable levels of fT4 (1.3 ± 0.3 vs 1.3 ± 0.3, p = NS). When corrected for established predictors of poor outcome in HF, the presence of SH resulted to be an independent predictor of cardiovascular mortality (HR: 2.96; 5–95% CI:1.13–7.74; p = 0.03). Since thyroid tests are widely available and inexpensive, they should be performed in HF patients to detect subclinical disorders, evaluate replacement therapy, and improve prognosis.
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Metadata
Title
Subclinical hypothyroidism predicts outcome in heart failure: insights from the T.O.S.CA. registry
Authors
Mariarosaria De Luca
Roberta D’Assante
Massimo Iacoviello
Vincenzo Triggiani
Giuseppe Rengo
Alfredo De Giorgi
Giuseppe Limongelli
Daniele Masarone
Maurizio Volterrani
Antonio Mancini
Andrea Passantino
Pasquale Perrone Filardi
Angela Sciacqua
Olga Vriz
Roberto Castello
Michela Campo
Giuseppe Lisco
Pietro Amedeo Modesti
Stefania Paolillo
Toru Suzuki
Andrea Salzano
Alberto Maria Marra
Eduardo Bossone
Antonio Cittadini
T.O.S.CA. Investigators
Publication date
08-06-2024
Publisher
Springer International Publishing
Published in
Internal and Emergency Medicine
Print ISSN: 1828-0447
Electronic ISSN: 1970-9366
DOI
https://doi.org/10.1007/s11739-024-03665-w
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