Although subclinical hypothyroidism is frequently diagnosed, the decision t
o institute a substitutive therapy with L-T-4 remains controversial. Becaus
e the cardiovascular system is considered a main target for the action of t
hyroid hormone, we investigated whether subclinical hypothyroidism induces
cardiovascular abnormalities.
Twenty-six patients (mean age, 36 +/- 12 yr) were evaluated by Doppler-echo
cardiography, whereas a subgroup of 10 patients, randomly selected, were re
evaluated after 6 months of L-T-4 substitutive therapy (mean dose, 68 mu g
daily). Thirty subjects (matched for age, sex, and body surface area) serve
d as controls.
Mean plasma TSH was significantly higher in patients (P < 0.001), whereas m
ean serum free T-4 and free T-3 concentrations, although in the normal rang
e, were significantly lower (P < 0.001 and P < 0.005, respectively). Blood
pressure and heart rate did not differ from control values. Echocardiogram
examination showed no abnormalities of the left ventricular morphology and
a slight, but not significant, reduction in the systolic function in the pa
tient group. In contrast, Doppler-derived indices of diastolic function sho
wed significant prolongation of the isovolumic relaxation time (94 +/- 13 v
s. 84 +/- 8 msec; P < 0.001). increased A wave (55 +/- 13 vs. 48 +/- 9 cm/s
ec; P < 0.05), and reduced early diastolic mitral flow velocity/late diasto
lic mitral flow velocity ratio (1.4 +/- 0.3 vs. 1.7 +/- 0.3; P < 0.001). In
the subgroup of 10 patients, thyroid hormone profile was normalized by 6 m
onths of L-T-4 substitutive therapy, whereas no changes were observed in th
e left ventricular morphology. Systolic function was significantly enhanced
, as compared with pretreatment values (P < 0.01) but did not differ from c
ontrol values. Also, systemic vascular resistance was significantly decreas
ed by L-T-4 replacement therapy. Assessment of diastolic function showed si
gnificant shortening of isovolumic relaxation time (77 +/- 15 vs. 91 +/- 8;
P < 0.05), reduction of A wave (51 +/- 13 vs. 60 +/- 12; P < 0.01), and in
crease of early diastolic mitral flow velocity/late diastolic mitral flow v
elocity ratio (1.7 +/- 0.4 vs. 1.3 +/- 0.3; P < 0.001).
These indices, however, were comparable with those of control subjects. The
se findings indicate that subclinical hypothyroidism affects diastolic func
tion and that this abnormality may be reversed by L-T, substitutive therapy
.