Long-Term Cardiovascular Effects of Levothyroxine Therapy in Young Adults with Congenital Hypothyroidism

• Published in: The journal of clinical endocrinology and metabolism Vol. 93; no. 7; pp. 2486 - 2491
• Main Authors: Salerno, Mariacarolina, Oliviero, Ugo, Lettiero, Teresa, Guardasole, Vincenzo, Mattiacci, Dario Maria, Saldamarco, Lavinia, Capalbo, Donatella, Lucariello, Antonio, Saccà, Luigi, Cittadini, Antonio
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01-07-2008
• Subjects: Adolescent; Adult; Biological and medical sciences; Cardiovascular System - drug effects; Carotid Arteries - drug effects; Carotid Arteries - pathology; Congenital Hypothyroidism - drug therapy; Congenital Hypothyroidism - physiopathology; Endocrinopathies; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; Humans; Linear Models; Male; Medical sciences; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Oxygen Consumption - drug effects; Thyroid. Thyroid axis (diseases); Thyrotropin - blood; Thyroxine - adverse effects; Ventricular Function, Left - drug effects; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Endocrinopathy; Human; Obesity; Congenital; Nutrition; Thyroid diseases; Nutrition disorder; Metabolic diseases; Hypothyroidism; Long term; Congenital disease; Treatment; Young adult; Circulatory system; Endocrinology; Nutritional status
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.2007-2315

Context: Congenital hypothyroidism (CH) is the most prevalent endocrine disorder in the newborn and is routinely treated with life-long levothyroxine replacement therapy. Although several studies have demonstrated that such therapy may impact on the cardiovascular system, little is known with regard to the effects of long-term levothyroxine administration in patients with CH.
Objective: The aim of the current study was to evaluate whether long-term levothyroxine replacement therapy in young adults with CH is associated with cardiovascular abnormalities.
Patients and Methods: Thirty young adults with CH aged 18.1 ± 0.2 yr and 30 age- and sex-matched controls underwent cardiac and carotid Doppler ultrasound and symptom-limited cardiopulmonary exercise testing. Hypothyroidism was diagnosed by neonatal screening, and levothyroxine treatment was initiated within the first month of life and carefully adjusted to maintain TSH levels in the normal range and free T4 in the high-normal range.
Results: Compared with controls, hypothyroid patients exhibited left ventricular diastolic dysfunction, impaired exercise capacity, and increased intima-media thickness. At multiple regression analysis, the number of episodes of plasma TSH levels less than 0.5 mU/liter and greater than 4.0 mU/liter from the age of 1 yr onward, and mean TSH plasma levels during puberty were independent predictors of diastolic filling and cardiopulmonary performance indexes (multiple r values: 0.61–0.75).
Conclusions: Long-term levothyroxine treatment in young adults with congenital hypothyroidism is associated with impaired diastolic function and exercise capacity and increased intima-media thickness.