Key result
Thyroid dysfunction is associated with increased carotid intima-media thickness, while levothyroxine replacement led to a significant decrease in IMT after 1 year in most studies.
Why the study?
Thyroid dysfunction has been associated with cardiovascular disease, but the association between thyroid dysfunction and atherosclerosis and the effect of L-T4 replacement on atherosclerosis progression required evaluation.
Does levothyroxine replacement reduce carotid intima-media thickness in patients with thyroid dysfunction?
Systematic Review (n=36,434)
Does levothyroxine replacement reduce carotid intima-media thickness in patients with thyroid dysfunction?
Thyroid dysfunction is associated with increased carotid intima-media thickness, which may be significantly decreased by levothyroxine replacement after 1 year.
Levothyroxine may reduce IMT in thyroid dysfunction; confirms vascular association and supports outcome trials.
BACKGROUND/AIM: Thyroid dysfunction, both hypo- and hyperthyroidism, has been associated with cardiovascular disease. The aim of this study was to evaluate the association between thyroid dysfunction and atherosclerosis measured mostly by carotid intima-media thickness, as well as discuss whether L-T4 replacement is able to reverse or slow down the progression of atherosclerosis. MATERIALS AND METHODS: The review was conducted according the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We performed on PubMed a literature search from May 2004 to January 2020, using the search terms 'subclinical hypothyroidism' or 'thyroid disorders' and 'carotid artery', 'carotid intima-media thickness (IMT)', 'levothyroxine', and 'atherosclerosis'. RESULTS: Twenty-six studies were eligible and included in the analysis. Overall, the studies encompassed a total of 36.434 patients included in this review. Most studies indicated a proportional correlation between IMT and thyroid dysfunction. Levothyroxine (L-T4) replacement led to significant decrease of IMT after 1 year in most studies. CONCLUSION: Most studies have concluded that thyroid dysfunction is associated with arterial wall remodeling and, thus, with increased cardiovascular risk. However, the exact mechanistic background of pathological structural changes in the arterial wall is still unsettled. Large randomized controlled studies are required to definitively address the extent to which T4 replacement therapy might benefit patients with subclinical thyroid disorders.
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Παπαδοπούλου et al. (2020) conducted a systematic review in Thyroid dysfunction (n=36,434). Thyroid dysfunction and Levothyroxine (L-T4) replacement was evaluated on Carotid intima-media thickness (IMT). Thyroid dysfunction is associated with increased carotid intima-media thickness, while levothyroxine replacement led to a significant decrease in IMT after 1 year in most studies.
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