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Giorgio Iervasi, MD; Sabrina Molinaro, PhD; Patrizia Landi, BSc; Maria Chiara Taddei, BSc; Elena Galli, MD; Fabio Mariani, PhD; Antonio L’Abbate, MD; Alessandro Pingitore, MD, PhD

Arch Intern Med. 2007;167(14):1526-1532.

Background  The effects of subclinical thyroid dysfunction on cardiac outcome are not well defined.

Methods  To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T₃).

Results  After mean follow-up of 32 months, there were 65 and 140 cardiac and overall deaths (3.4% and 7.3%), respectively, in euthyroidism, 15 and 27 (7.2% and 13.0%) in SCH, 8 and 9 (8.2% and 9.2%) in SCT, and 59 and 119 (6.5% and 13.1%) in low T₃. Survival rates for cardiac death were lower in SCH, SCT, and low T₃ than in euthyroidism (log-rank test; ² = 19.46; P < .001). Survival rates for overall death were lower in SCH and low T₃ than in euthyroidism (log-rank test; ² = 26.67; P < .001). After adjustment for several risk factors, hazard ratios (HRs) for cardiac death were higher in SCH (HR, 2.40; 95% confidence interval [CI], 1.36-4.21; P = .02), SCT (HR, 2.32; 95% CI, 1.11-4.85; P = .02), and low T₃ (HR, 1.63; 95% CI, 1.14-2.33; P = .007) than in euthyroidism; HRs for overall death were higher in SCH (HR, 2.01; 95% CI, 1.33-3.04; P < .001) and low T₃ (HR, 1.57; 95% CI, 1.22-2.01; P < .001) but not in SCT.

Conclusion  A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease.

Author Affiliations: Clinical Physiology Institute (Drs Iervasi and Pingitore and Mss Landi and Taddei) and Epidemiology and Biostatistics Section (Drs Molinaro and Mariani), National Council of Research, and Scuola Superiore di Studi Universitari S’Anna (Drs Galli and L’Abbate), Pisa, Italy.

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