Long-term cardiovascular effects of levothyroxine therapy in young adults with congenital hypothyroidism.
BACKGROUND
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.


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 T(4) 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.
Salerno
Mariacarolina
M
Department of Internal Medicine and Cardiovascular Sciences, University Federico II, Via S. Pansini 5, Naples, Italy.
Oliviero
Ugo
U
Lettiero
Teresa
T
Guardasole
Vincenzo
V
Mattiacci
Dario Maria
DM
Saldamarco
Lavinia
L
Capalbo
Donatella
D
Lucariello
Antonio
A
Saccà
Luigi
L
Cittadini
Antonio
A
D000293:Adolescent; D000328:Adult; D002319:Cardiovascular System / Q000187:drug effects*; D002339:Carotid Arteries / Q000187:drug effects / Q000473:pathology; D003409:Congenital Hypothyroidism / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D010101:Oxygen Consumption / Q000187:drug effects; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000009:adverse effects*; D016277:Ventricular Function, Left / Q000187:drug effects
D013972:Thyrotropin; D013974:Thyroxine