title: Subclinical hypothyroidism in combination with vitamin D deficiency increases the risk of impaired left ventricular diastolic function.
abstract: OBJECTIVE
  Subclinical hypothyroidism and vitamin D deficiency are common. The diastolic function of patients with both subclinical hypothyroidism and vitamin D deficiency remains unknown. This study aimed to investigate diastolic dysfunction in patients with both subclinical hypothyroidism and vitamin D deficiency.
  
  
  METHODS
  This study included 254 patients. All patients underwent standard Doppler echocardiography. Patients who had risk factors for diastolic dysfunction or had used L-thyroxine and vitamin D within the previous 3 months were excluded. Vitamin D deficiency was defined as a 25-OH-vitamin D level lower than 20 ng/ml, and vitamin D sufficiency was defined as a 25-OH-vitamin D level ≥ 30 ng/ml. Subclinical hypothyroidism was defined as a TSH level of 4.5-10 mU/l when the free T4 concentration was normal.
  
  
  RESULTS
  The patients were divided into 4 groups. Group 1 (n=71) included patients with subclinical hypothyroidism and vitamin D deficiency; Group 2 (n=66) included patients with subclinical hypothyroidism and vitamin D sufficiency; Group 3 (n=65) included euthyroid patients with vitamin D deficiency; and Group 4 (n=52) included euthyroid patients with vitamin D sufficiency. LAVI (31.3 ± 3.2, 28.7 ± 3.0, 28.4 ± 3.4, and 27.9 ± 3.9; p<0.001) and E/E' values (11.2 ± 2.7, 8.9 ± 2.7, 9.1 ± 2.9, 8.8 ± 2.5; p<0.001) were significantly higher in Group 1 than in Groups 2, 3 and 4. E' values were significantly lower in Group 1 than in Groups 2, 3 and 4.
  
  
  CONCLUSIONS
  The coexistence of subclinical hypothyroidism with vitamin D deficiency can lead to further deterioration in the LV diastolic function via the regulation of intracellular calcium and induction of inflammatory activity. Therefore, close follow-up of the diastolic functions of these patients could be beneficial.
authors.forename: H
authors.initials: H
authors.lastname: Yilmaz
authors.forename: M
authors.initials: M
authors.lastname: Cakmak
authors.forename: T
authors.initials: T
authors.lastname: Darcin
authors.forename: O
authors.initials: O
authors.lastname: Inan
authors.forename: O M
authors.initials: OM
authors.lastname: Gurel
authors.forename: M A
authors.initials: MA
authors.lastname: Bilgic
authors.forename: N
authors.initials: N
authors.lastname: Bavbek
authors.forename: A
authors.initials: A
authors.lastname: Akcay
mesh_terms: D000328:Adult; D058070:Asymptomatic Diseases; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016277:Ventricular Function, Left; D014808:Vitamin D Deficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: diastolic function; echocardiography.; subclinical hypothyroidism; vitamin D deficiency