title: Subclinical hypothyroidism in grown-up congenital heart disease patients.
abstract: Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.
authors.affiliation: Servicio de Cardiología, Complejo Hospitalario Universitario Insular-Materno Infantil, Avda. Marítima del Sur s/n, 35016, Las Palmas, Spain. efrencardio@gmail.com
authors.forename: Efrén
authors.initials: E
authors.lastname: Martínez-Quintana
authors.forename: Fayna
authors.initials: F
authors.lastname: Rodríguez-González
authors.forename: Vicente
authors.initials: V
authors.lastname: Nieto-Lago
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications*; D006801:Humans; D007037:Hypothyroidism / Q000097:blood* / Q000175:diagnosis*; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011507:Proteinuria / Q000175:diagnosis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013972:Thyrotropin / Q000097:blood
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D013972:Thyrotropin; D002097:C-Reactive Protein; D002784:Cholesterol; D003404:Creatinine