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J Atheroscler Thromb. 2017 Jul 1;24(7):643-659. doi: 10.5551/jat.39917. Epub 2017 May 31.

Effect of Thyroxin Treatment on Carotid Intima-Media Thickness (CIMT) Reduction in Patients with Subclinical Hypothyroidism (SCH): a Meta-Analysis of Clinical Trials.

Author information

1
Center for Healthcare Advancement & Outcomes, Baptist Health South Florida.
2
Benedictine University, Department of Public Health.
3
Ocala Regional Medical Center.
4
Baptist Health South Florida, Wellness Advantage.
5
Department of Internal Medicine, Creighton University Medical Center.
6
Florida International University, Department of Epidemiology, Robert Stempel College of Public Health.
7
Director High Risk Cardiovascular Disease Clinic, Baptist Health South Florida.
8
Florida International University, Department of Medicine, Herbert Wertheim College of Medicine.
9
Johns Hopkins University, Johns Hopkins Ciccarone Center for Prevention of Heart Disease.

Abstract

AIM:

Research shows that subclinical hypothyroidism (SCH) is related to an increased carotid intima-media thickness (CIMT), a surrogate marker of subclinical cardiovascular disease (CVD). It is controversial whether or not SCH should be treated to reduce CVD morbidity and mortality. This meta-analysis aimed to determine whether SCH is associated with an increase in CIMT as compared to Euthyroidism (EU) and whether thyroxin (T4) treatment in SCH can reverse the change in CIMT.

METHODS:

Two independent reviewers conducted an extensive database research up to December 2016. A total of 12 clinical trials discussed the effect of Thyroxin on CIMT values at pre- and post-treatment in subjects with SCH.

RESULTS:

CIMT was significantly higher among SCH (n=280) as compared to EU controls (n=263) at baseline; the pooled weighted mean difference (WMD) of CIMT was 0.44 mm [95% confidence interval (CI) 0.14, 0.74], p=0.004; I2=65%. After treatment with thyroxin in subjects with SCH (n=314), there was a statistically significant decrease in CIMT from pre- to post-treatment; the pooled WMD of CIMT decrease was [WMD -0.32; 95% CI (-0.47, -0.16), p=<0.0001; I2=2%], and it was no longer different from EU controls [WMD 0.13 mm; 95% CI (-0.04, 0.30); p=0.14; I2=27%]. The total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) were higher in SCH as compared to EU controls and decreased significantly after treatment with thyroxin.

CONCLUSION:

This meta-analysis shows that thyroxin therapy in subjects with SCH significantly decreases CIMT and improves lipid profile, modifiable CVD risk factors. Thyroid hormone replacement in subjects with SCH may play a role in slowing down or preventing the progression of atherosclerosis.

KEYWORDS:

Carotid intima-media thickness; Clinical trials; Dyslipidemia; Euthyroid/Euthyroidism; Meta-analysis; Subclinical hypothyroidism; Thyroxin treatment

PMID:
28566564
PMCID:
PMC5517537
DOI:
10.5551/jat.39917
[Indexed for MEDLINE]
Free PMC Article

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