Thyroid functional disease

An under-recognized cardiovascular risk factor in kidney disease patients

Connie M. Rhee, Gregory A. Brent, Csaba P. Kovesdy, Offie P. Soldin, Danh Nguyen, Matthew J. Budoff, Steven M. Brunelli, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Thyroid functional disease, and in particular hypothyroidism, is highly prevalent among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In the general population, hypothyroidism is associated with impaired cardiac contractility, endothelial dysfunction, atherosclerosis and possibly higher cardiovascular mortality. It has been hypothesized that hypothyroidism is an under-recognized, modifiable risk factor for the enormous burden of cardiovascular disease and death in CKD and ESRD, but this has been difficult to test due to the challenge of accurate thyroid functional assessment in uremia. Low thyroid hormone levels (i.e. triiodothyronine) have been associated with adverse cardiovascular sequelae in CKD and ESRD patients, but these metrics are confounded by malnutrition, inflammation and comorbid states, and hence may signify nonthyroidal illness (i.e. thyroid functional test derangements associated with underlying ill health in the absence of thyroid pathology). Thyrotropin is considered a sensitive and specific thyroid function measure that may more accurately classify hypothyroidism, but few studies have examined the clinical significance of thyrotropin-defined hypothyroidism in CKD and ESRD. Of even greater uncertainty are the risks and benefits of thyroid hormone replacement, which bear a narrow therapeutic-to-toxic window and are frequently prescribed to CKD and ESRD patients. In this review, we discuss mechanisms by which hypothyroidism adversely affects cardiovascular health; examine the prognostic implications of hypothyroidism, thyroid hormone alterations and exogenous thyroid hormone replacement in CKD and ESRD; and identify areas of uncertainty related to the interplay between hypothyroidism, cardiovascular disease and kidney disease requiring further investigation.

Original languageEnglish (US)
Pages (from-to)724-737
Number of pages14
JournalNephrology Dialysis Transplantation
Volume30
Issue number5
DOIs
StatePublished - May 1 2015

Fingerprint

Thyroid Diseases
Kidney Diseases
Hypothyroidism
Chronic Renal Insufficiency
Chronic Kidney Failure
Thyroid Hormones
Thyroid Gland
Thyrotropin
Uncertainty
Cardiovascular Diseases
Uremia
Poisons
Health
Triiodothyronine
Malnutrition
Atherosclerosis
Pathology
Inflammation
Mortality
Population

Keywords

  • cardiovascular risk
  • hyperthyrotropinemia
  • hypothyroidism
  • renal failure
  • thyroid functional disease

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

Rhee, C. M., Brent, G. A., Kovesdy, C. P., Soldin, O. P., Nguyen, D., Budoff, M. J., ... Kalantar-Zadeh, K. (2015). Thyroid functional disease: An under-recognized cardiovascular risk factor in kidney disease patients. Nephrology Dialysis Transplantation, 30(5), 724-737. https://doi.org/10.1093/ndt/gfu024

Thyroid functional disease : An under-recognized cardiovascular risk factor in kidney disease patients. / Rhee, Connie M.; Brent, Gregory A.; Kovesdy, Csaba P.; Soldin, Offie P.; Nguyen, Danh; Budoff, Matthew J.; Brunelli, Steven M.; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 30, No. 5, 01.05.2015, p. 724-737.

Research output: Contribution to journalArticle

Rhee, CM, Brent, GA, Kovesdy, CP, Soldin, OP, Nguyen, D, Budoff, MJ, Brunelli, SM & Kalantar-Zadeh, K 2015, 'Thyroid functional disease: An under-recognized cardiovascular risk factor in kidney disease patients', Nephrology Dialysis Transplantation, vol. 30, no. 5, pp. 724-737. https://doi.org/10.1093/ndt/gfu024
Rhee, Connie M. ; Brent, Gregory A. ; Kovesdy, Csaba P. ; Soldin, Offie P. ; Nguyen, Danh ; Budoff, Matthew J. ; Brunelli, Steven M. ; Kalantar-Zadeh, Kamyar. / Thyroid functional disease : An under-recognized cardiovascular risk factor in kidney disease patients. In: Nephrology Dialysis Transplantation. 2015 ; Vol. 30, No. 5. pp. 724-737.
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