Improved Endothelial Function and Lipid Profile Compensate for Impaired Hemostatic and Inflammatory Status in Iatrogenic Chronic Subclinical Hyperthyroidism of Thyroid Cancer Patients on L-T₄ Therapy

Abstract

Objective We aimed to compare the changes of endothelial function and haemostatic, inflammatory and metabolic parameters of short-term iatrogenic hypothyroidism to the characteristics of subclinical hyperthyroidism in patients with differentiated thyroid cancer.

Design Twenty four women (mean age 42.4±8.1 years) had undergone total thyroidectomy and radioiodine ablation in treatment for differentiated thyroid cancer. We measured serum thyroglobulin, thyroid function, plasma levels of lipid parameters, homocystine, C-reactive protein, fibrinogen, von Willebrandt factor activity (vWF), nitric oxide, as well as flow-mediated vasodilatation (FMD) and nitroglycerin-mediated vasodilatation of the brachial artery during iatrogenic hypothyroidism (TSH 89.82±29.36 mU/L) and again in the same patients during subclinical hyperthyroidism secondary to exogenous levothyroxine administration (TSH 0.24±0.11 mU/L).

Results In hypothyroidism, FMD was markedly lower than in subclinical hyperthyroidism (6.79±4.44 vs. 14.37±8.33%, p<0.005). Total cholesterol (7.34±1.23 vs. 4.75±1.14 mmol/L, p<0.001), LDL-cholesterol (4.55±1.10 vs. 2.70±0.89 mmol/L, p<0.005) and homocystine (12.95±4.49 vs. 9.62±2.29 μmol/L, p<0.005) were significantly higher in hypothyroidism. There was no difference in nitroglycerin-mediated vasodilatation, blood pressure, serum triglyceride and HDL-cholesterol levels according to thyroid function. Fibrinogen (3.23±0.50 vs. 4.01±0.84  g/L, p<0.005), vWF (90.09±25.92 vs.130.63±29.97%, p<0.001), C-reactive protein (4.39±5.16 vs. 5.55±5.15 mg/L, p<0.001) and plasma nitric oxide (24.56±6.71 vs. 32.34±7.0 μmol/L, <0.005) values were significantly lower in hypothyroidism. FMD correlated in a positive manner with fibrinogen, vWF and nitrogen oxide.

Conclusions Chronic subclinical hyperthyroidism was associated with improved endothelial function and lipid profile, while haemostatic and inflammatory parameters were impaired. The two opposite mechanisms may well compensate for each other at the level of the vessel wall.

Key words

cardiovascular risk - endothelial function - vascular injury markers - hypothyroidism - hyperthyroidism

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