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Should we treat all subjects with subclinical thyroid disease the same way?

B Biondi, Dept of Molecular and Clinical Endocrinology and Oncology, University of Naples Federico II, Naples, 80131, Italy

Correspondence: Bernadette Biondi, Email: bebiondi{at}libero.it

Abstract

Overt hypothyroidism and hyperthyroidism are associated with an increased cardiovascular risk.

There is extensive evidence that the cardiovascular system responds to minimal but persistent changes in thyroid hormone levels, which are typical of individuals with persistent subclinical thyroid dysfunction. However, opinions differ about the deleterious effects of subclinical thyroid disease (SCTD) on cardiovascular mortality. Various recent meta-analyses have examined the cardiovascular risk associated with subclinical hyperthyroidism (SHyper) with the aim of establishing whether treatment should be considered in young and middle-aged patients and in the elderly. Several novel aspects emerge from the meta-analysis by Haentjens et al. that appears in this issue of the European Journal of Endocrinology. The results of this meta-analysis support the concept that cardiovascular function should be assessed in subjects with SCTD. The cardiovascular risk of SCTD depends on the age of the patients and co-morbidity conditions. The cardiovascular risk is higher in elderly persons with SHyper. Untreated SHyper is more harmful in patients with associated co-morbidity conditions and in elderly subjects.

On the contrary, middle-aged individuals with subclinical hypothyroidism (SHypo) have a higher risk for chronic heart disease than elderly patients with SHypo. It is conceivable that SHypo exerts a protective effect in very elderly subjects.