ABSTRACT Subclinical hypothyroidism (SCH), characterized by elevated thyroid-stimulating hormone levels (typically >4.5–5.0 mIU/L) with normal free thyroxine concentrations, affects 3%–16.9% of the general Indian population, with prevalence increasing substantially with age, particularly among women. This comprehensive review examines current evidence linking SCH to coronary artery calcium (CAC) scores in elderly individuals, exploring underlying pathophysiological mechanisms, diagnostic considerations, and clinical implications. Multiple studies demonstrate that SCH patients have significantly higher CAC scores compared to euthyroid controls, with increased prevalence of moderate to severe coronary calcification (CAC >100–400). The relationship is mediated through multiple mechanisms, including lipid metabolism alterations (elevated low-density lipoprotein cholesterol LDL-C and oxidized LDL), endothelial dysfunction with impaired nitric oxide production, chronic low-grade inflammation (elevated C-reactive protein, interleukin-6), and direct vascular effects promoting calcium deposition. CAC scoring provides an objective assessment of atherosclerotic burden and may enhance cardiovascular risk stratification in elderly SCH patients, particularly identifying high-risk individuals misclassified by traditional risk scores like Framingham. Treatment decisions remain individualized based on age, thyroid-stimulating hormone levels, symptoms, and cardiovascular risk factors, with CAC scoring potentially guiding personalized therapeutic strategies in this vulnerable population.
Rahul Garg (2026) studied this question.