Hypothyroidism: playing the cardiometabolic risk concerto
Abstract Background Thyroid hormones influence the function of essentially every system of the body, including the cardiovascular and metabolic system. Thyroid hormone replacement with levothyroxine (LT4) is the mainstay of pharmacological management for people with (especially clinically overt) hyp...
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BMC
2025-05-01
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| Series: | Thyroid Research |
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| Online Access: | https://doi.org/10.1186/s13044-025-00233-y |
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| author | George J. Kahaly Youshuo Liu Luca Persani |
| author_facet | George J. Kahaly Youshuo Liu Luca Persani |
| author_sort | George J. Kahaly |
| collection | DOAJ |
| description | Abstract Background Thyroid hormones influence the function of essentially every system of the body, including the cardiovascular and metabolic system. Thyroid hormone replacement with levothyroxine (LT4) is the mainstay of pharmacological management for people with (especially clinically overt) hypothyroidism, and it is important to ensure the cardiovascular and metabolic safety of this treatment. This is especially so as in hypothyroidism, cardiometabolic risk factors and cardiovascular disease are highly prevalent conditions and will often coexist in an individual patient. Accordingly, we have reviewed the cardiometabolic consequences of hypothyroidism and intervention with thyroid hormone replacement. Main body Numerous observational studies and meta-analyses have described multiple potentially adverse cardiometabolic consequences of hypothyroidism, including exacerbation of cardiovascular and metabolic risk factors (especially dyslipidaemia), functional impairment of the heart and vasculature (including accelerated atherosclerosis) and increased risk of advanced cardiovascular outcomes. LT4 usually improves cardiometabolic risk factors in people with hypothyroidism and some (but not all) studies have reported improved vascular and cardiac function in LT4-treated populations. Observational data have suggested the possibility of improved cardiometabolic outcomes with LT4 treatment, particularly in younger people with hypothyroidism, although data from randomised, controlled trials are needed here. Importantly, LT4 (with or without additional triiodothyronine) appears to be safe from a cardiovascular perspective, as long as overtreatment and iatrogenic thyrotoxicosis are avoided. Conclusions Overall, the current evidence base supports intervention with LT4 to protect the cardiometabolic health of people with hypothyroidism who require thyroid hormone replacement, although more data on long-term clinical outcomes are needed. |
| format | Article |
| id | doaj-art-de13ebf6c3314680960c782445fd0332 |
| institution | OA Journals |
| issn | 1756-6614 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Thyroid Research |
| spelling | doaj-art-de13ebf6c3314680960c782445fd03322025-08-20T02:34:02ZengBMCThyroid Research1756-66142025-05-0118111510.1186/s13044-025-00233-yHypothyroidism: playing the cardiometabolic risk concertoGeorge J. Kahaly0Youshuo Liu1Luca Persani2Department of Medicine I, Johannes Gutenberg University (JGU) Medical CenterDepartment of Geriatrics and Geriatric Endocrinology, Institute of Aging and Age-Related Disease Research, The Second Xiangya Hospital of Central South University, Central South UniversityDepartment of Medical Biotechnology and Translational Medicine, University of MilanAbstract Background Thyroid hormones influence the function of essentially every system of the body, including the cardiovascular and metabolic system. Thyroid hormone replacement with levothyroxine (LT4) is the mainstay of pharmacological management for people with (especially clinically overt) hypothyroidism, and it is important to ensure the cardiovascular and metabolic safety of this treatment. This is especially so as in hypothyroidism, cardiometabolic risk factors and cardiovascular disease are highly prevalent conditions and will often coexist in an individual patient. Accordingly, we have reviewed the cardiometabolic consequences of hypothyroidism and intervention with thyroid hormone replacement. Main body Numerous observational studies and meta-analyses have described multiple potentially adverse cardiometabolic consequences of hypothyroidism, including exacerbation of cardiovascular and metabolic risk factors (especially dyslipidaemia), functional impairment of the heart and vasculature (including accelerated atherosclerosis) and increased risk of advanced cardiovascular outcomes. LT4 usually improves cardiometabolic risk factors in people with hypothyroidism and some (but not all) studies have reported improved vascular and cardiac function in LT4-treated populations. Observational data have suggested the possibility of improved cardiometabolic outcomes with LT4 treatment, particularly in younger people with hypothyroidism, although data from randomised, controlled trials are needed here. Importantly, LT4 (with or without additional triiodothyronine) appears to be safe from a cardiovascular perspective, as long as overtreatment and iatrogenic thyrotoxicosis are avoided. Conclusions Overall, the current evidence base supports intervention with LT4 to protect the cardiometabolic health of people with hypothyroidism who require thyroid hormone replacement, although more data on long-term clinical outcomes are needed.https://doi.org/10.1186/s13044-025-00233-yHypothyroidismCardiometabolic risk factorsCardiometabolic outcomesLevothyroxineTriiodothyronineDrug safety |
| spellingShingle | George J. Kahaly Youshuo Liu Luca Persani Hypothyroidism: playing the cardiometabolic risk concerto Thyroid Research Hypothyroidism Cardiometabolic risk factors Cardiometabolic outcomes Levothyroxine Triiodothyronine Drug safety |
| title | Hypothyroidism: playing the cardiometabolic risk concerto |
| title_full | Hypothyroidism: playing the cardiometabolic risk concerto |
| title_fullStr | Hypothyroidism: playing the cardiometabolic risk concerto |
| title_full_unstemmed | Hypothyroidism: playing the cardiometabolic risk concerto |
| title_short | Hypothyroidism: playing the cardiometabolic risk concerto |
| title_sort | hypothyroidism playing the cardiometabolic risk concerto |
| topic | Hypothyroidism Cardiometabolic risk factors Cardiometabolic outcomes Levothyroxine Triiodothyronine Drug safety |
| url | https://doi.org/10.1186/s13044-025-00233-y |
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