title: Thyroid function, cardiovascular events, and mortality in diabetic hemodialysis patients.
abstract: BACKGROUND
  In dialysis patients, the prevalence of thyroid disorders and their impact on specific cardiovascular (CV) events and mortality are largely unknown. The aim of the present study was to analyze whether subclinical thyroid disorders were associated with CV events and mortality.
  
  
  METHODS
  Prospective multicenter cohort study.
  
  
  METHODS
  Thyroid status and clinical outcomes were explored in 1,000 diabetic hemodialysis patients from 178 centers in Germany.
  
  
  METHODS
  Thyroid status, defined by the following cutoff values: euthyroidism (thyrotropin [TSH], 0.30-4.0 mIU/L; free triiodothyronine [T3], 2.7-7.6 pmol/L; and free thyroxine [T4], 11.0-24.0 pmol/L), subclinical hyperthyroidism (TSH<0.3 mIU/L and free T3/free T4 within reference ranges), subclinical hypothyroidism (TSH, 4.1-15.0 mIU/L and free T3/free T4 within reference ranges), euthyroid sick syndrome (free T3<2.7 pmol/L and TSH/free T4 low or within reference ranges).
  
  
  RESULTS
  During 4 years' follow-up, prespecified adjudicated end points were determined: sudden cardiac death, myocardial infarction, stroke, combined CV events, and overall mortality. Short-term effects within the first 12 months were contrasted to long-term effects (years 2-4).
  
  
  METHODS
  TSH, free T3, and free T4 levels at baseline.
  
  
  RESULTS
  Euthyroidism was present in 78.1% of patients; subclinical hyperthyroidism, in 13.7%; and subclinical hypothyroidism, in 1.6%. Euthyroid sick syndrome was exhibited by 5.4% of patients. The adjusted short-term risk of sudden cardiac death was more than doubled (HR, 2.03; 95% CI, 0.94-4.36) in patients with subclinical hyperthyroidism, and similarly for patients with euthyroid sick syndrome (HR, 2.74; 95% CI, 0.94-7.98) compared with patients with euthyroidism. Short-term mortality was increased almost 3-fold for patients with euthyroid sick syndrome (HR, 2.97; 95% CI, 1.66-5.29), but this effect was not seen in the long term. Subclinical hypothyroidism was not associated with CV events or all-cause mortality. Risks of stroke and myocardial infarction were not affected meaningfully by thyroid disorders.
  
  
  CONCLUSIONS
  Observational study design.
  
  
  CONCLUSIONS
  Sudden cardiac death may be influenced by subclinical hyperthyroidism and euthyroid sick syndrome in the short term. Furthermore, euthyroid sick syndrome is associated strongly with mortality in hemodialysis patients. Regular assessment of thyroid status may help estimate the cardiac risk of dialysis patients.
authors: Department of Medicine 1, Division of Nephrology, University Hospital, University of Würzburg, Würzburg, Germany; Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany. Electronic address: drechsler_c@ukw.de.
authors: Christiane
authors: C
authors: Drechsler
authors: Department of Medicine 1, Division of Nephrology, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors: Andreas
authors: A
authors: Schneider
authors: Department of Medicine 1, Division of Nephrology, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors: Lena
authors: L
authors: Gutjahr-Lengsfeld
authors: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Endocrine and Diabetes Unit, Department of Medicine 1, University Hospital, University of Würzburg, Würzburg, Germany.
authors: Matthias
authors: M
authors: Kroiss
authors: Division of Renal Medicine and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
authors: Juan Jesús
authors: JJ
authors: Carrero
authors: Department of Medicine 1, Division of Nephrology, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors: Vera
authors: V
authors: Krane
authors: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Endocrine and Diabetes Unit, Department of Medicine 1, University Hospital, University of Würzburg, Würzburg, Germany.
authors: Bruno
authors: B
authors: Allolio
authors: Department of Medicine 1, Division of Nephrology, University Hospital, University of Würzburg, Würzburg, Germany; Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany.
authors: Christoph
authors: C
authors: Wanner
authors: Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany; Endocrine and Diabetes Unit, Department of Medicine 1, University Hospital, University of Würzburg, Würzburg, Germany; Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians Universität München, Munich, Germany.
authors: Martin
authors: M
authors: Fassnacht
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D005067:Euthyroid Sick Syndromes / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D007037:Hypothyroidism / Q000453:epidemiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis; D012307:Risk Factors; D013959:Thyroid Diseases / Q000453:epidemiology* / Q000503:physiopathology
keywords: Thyroid disorder; cardiovascular disease; diabetes; end-stage renal disease; hemodialysis; subclinical thyroid dysfunction; thyroid-stimulating hormone (TSH); thyrotropin