Study Selection And Data Extraction
Two reviewers independently screened the abstracts and titles of the search results, and articles were eliminated only if they did not investigate the association between subclinical thyroid dysfunction and blood pressure levels. The same two reviewers independently evaluated studies for eligibility on the basis of the predefined set of eligibility criteria.
Information from each study was extracted independently by the two reviewers , using a standardized data extraction form. General characteristics of the study used and adjusted factors), characteristics of the subclinical thyroid dysfunction and euthyroid groups and results were recorded, where available, and double checked. Discrepancies in data extraction between reviewers were resolved by discussion.
Metabolism Of Thyroid Hormones And Their Effects On The Cardiovascular System
Triiodothyronine is the biologically active form of thyroid hormone derived from 5-monodeiodination of thyroxine in all tissues outside of the thyroid gland, particularly the kidney, liver, and skeletal muscle. The basal metabolic rate is affected by fT3 via altering oxygen consumption, substrate requirements and tissue thermogenesis . Thyroid hormones have direct and indirect cellular effects on the cardiovascular system. In hyperthyroidism systemic vascular resistance decreases as fT3 dilates resistance arterioles of the peripheral circulation, which results in the fall of the effective arterial filling followed by stimulation of renin release and activation of the angiotensin-aldosterone axis .
According to earlier studies heart failure develops in 616% of patients with hyperthyroidism. Patients with preexisting hypertension or with risk factors for coronary artery disease have a more pronounced risk for developing hemodynamic changes leading to chronic heart failure. A relatively frequent complication of hyperthyroidism, atrial fibrillation, is an independent predictor for the development of chronic heart failure .
We have previously shown that in patients who had undergone thyroidectomy for differentiated thyroid cancer, increased aortic stiffness and impaired diastolic function can be detected during induced overt hypothyroidism, which is part of the diagnostic follow-up procedure .
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How Do Doctors Diagnose Hashimotos Disease
Doctors diagnose Hashimotos disease based on
- medical history and physical exam. Your doctor will start by taking a medical history and performing a physical exam. In addition to asking about symptoms, the doctor will check your neck for a goiter, which some people with Hashimotos disease can develop.
- blood tests. Your doctor will order one or more blood tests to check for hypothyroidism and its causes. Examples include tests for
- the thyroid hormones T4 and T3
- thyroid-stimulating hormone, or TSH
- thyroid peroxidase antibodies , a type of thyroid antibody that is present in most people with Hashimotos disease
You probably wont need other tests to confirm you have Hashimotos disease. However, if your doctor suspects Hashimotos disease but you dont have antithyroid antibodies in your blood, you may have an ultrasound of your thyroid. The ultrasound images can show the size of your thyroid and other features of Hashimotos disease. The ultrasound also can rule out other causes of an enlarged thyroid, such as thyroid nodulessmall lumps in the thyroid gland.
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Blood Pressure Changes In Subclinical Hypothyroidism
Hypothyroidism has been generally considered as a cardiovascular risk factor, as discussed above, stressing the need of routine screening for thyroid function especially among female patients with coronary heart disease or patients with known cardiovascular risk factors . Subclinical hypothyroidism is a common entity, characterized by elevated TSH-levels and fT4 and fT3 levels in the normal range.
The association between elevated blood pressure and overt thyroid disorders has been thoroughly investigated and well-established, while the question whether subclinical changes in the thyroid function present potential risk for the development and maintenance of hypertension are still under debate. Some studies detected positive correlations of subclinical hypothyroidism and hypertension in women however, the same results were not confirmed in men . A number of clinical studies assessed the relationship between subclinical thyroid dysfunction, both hypo and hyperthyroidism, and endothelial dysfunction , arterial wall thickening , atrial fibrillation , and left ventricular hypertrophy . A study involving more than 10.000 children and adolescents found a positive correlation between elevated serum TSH levels and both systolic and diastolic blood pressure however, this correlation was not established with hypertension . Upon these findings, one can presume an association between subclinical hypothyroidism and elevated risk for the development of hypertension.
Can Hypothyroidism Be Prevented
Hypothyroidism cannot be prevented. The best way to prevent developing a serious form of the condition or having the symptoms impact your life in a serious way is to watch for signs of hypothyroidism. If you experience any of the symptoms of hypothyroidism, the best thing to do is talk to your healthcare provider. Hypothyroidism is very manageable if you catch it early and begin treatment.
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Thyroid Disorder And Hypertension
Both types of thyroid disorder can lead to hypertension, though they get there in different ways. Hyperthyroidism increases your heart rate and makes your heart work harder, while hypothyroidism weakens your heart muscle and makes it less efficient.
About 3% of people with hypertension have thyroid disorder, and its called secondary hypertension.
In those cases, the usual medications for treating blood pressure dont help lower it. However, treating the underlying thyroid condition along with anti-hypertensive treatments can help.
If youve been diagnosed with thyroid disorder and your blood pressure is consistently high, schedule an appointment at Heart & Vascular Institute. We offer expertise in both cardiology and endocrinology to help you live the healthiest life possible.
To schedule an appointment, call one of our convenient locations in Dearborn, Detroit, or Southfield, Michigan, or use our online booking tool.
Whats The Difference Between Hypothyroidism And Hyperthyroidism
In hypothyroidism, the thyroid doesnt make enough thyroid hormone.
The difference between hypothyroidism and hyperthyroidism is quantity. In hypothyroidism, the thyroid makes very little thyroid hormone. On the flip side, someone with hyperthyroidism has a thyroid that makes too much thyroid hormone. Hyperthyroidism involves higher levels of thyroid hormones, which makes your metabolism speed up. If you have hypothyroidism, your metabolism slows down.
Many things are the opposite between these two conditions. If you have hypothyroidism, you may have a difficult time dealing with the cold. If you have hyperthyroidism, you may not handle the heat. They are opposite extremes of thyroid function. Ideally, you should be in the middle. Treatments for both of these conditions work to get your thyroid function as close to that middle ground as possible.
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Increase In Peripheral Vascular Resistance
found that diastolic BP correlated significantly with thyroxine and 3,5,3-triiodothyronine in slightly hypothyroid females over 50 years of age.
triiodothyronine represents the metabolically active thyroid agent that possibly has a vasodilatory effect on the vascular muscle cells. Hypothyroidism and T3 deficiency are associated with peripheral vasoconstriction.Hypothyroidism has been associated with increased arterial stiffness.
On the other hand, the increased systolic and diastolic BP could induce changes in the arterial wall, reducing elasticity and increasing stiffness.
Adequate thyroid hormone replacement therapy successfully reduced BP, supporting the secondary cause of hypertension in patients with hypothyroidism.
The authors conclude that hypothyroidism causes aortic stiffness and hypertension . Thyroid hormone therapy decreases aortic stiffness, promoting decreased blood pressure in about 50 percent of these patients. Antihypertensive treatment further improves aortic elasticity and can decrease blood pressure among patients with hypertension and hypothyroidism whose blood pressure does not drop as thyroid function is normalized. Replacement of lacking thyroid hormones reduces high blood pressure and total cardiovascular risk.
References
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Have Potassium And Sodium Balance
Both nutrients are electrolytes responsible for keeping fluid balance and a good blood volume in your body. But, you can get high blood pressure with too much sodium and not enough potassium, and this is the reason why you need to maintain the right amounts of these electrolytes.
Potassium can help ease blood vessel tension and reduce the effect of sodium in your body. You can get potassium from these foods:
- Low-fat dairy food products like yogurt and milk
Will Hypothyroidism Make Me Gain Weight
If your hypothyroidism is not treated, you could gain weight. Once you are treating the condition, the weight should start to lower. However, you will still need to watch your calories and exercise to lose weight. Talk to your healthcare provider about weight loss and ways to develop a diet that works for you.
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What Are The Treatments For Hypothyroidism
The treatment for hypothyroidism is medicine to replace the hormone that your own thyroid can no longer make. About 6 to 8 weeks after you start taking the medicine, you will get a blood test to check your thyroid hormone level. Your health care provider will adjust your dose if needed. Each time your dose is adjusted, you’ll have another blood test. Once you find the right dose, you will probably get a blood test in 6 months. After that, you will need the test once a year.
If you take your medicine according to the instructions, you usually should be able to control the hypothyroidism. You should never stop taking your medicine without talking with your health care provider first.
If you have Hashimoto’s disease or other types of autoimmune thyroid disorders, you may be sensitive to harmful side effects from iodine. Talk to your health care provider about which foods, supplements, and medicines you need to avoid.
Women need more iodine when they are pregnant because the baby gets iodine from the mother’s diet. If you are pregnant, talk with your health care provider about how much iodine you need.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Breaking Down Blood Pressure Readings
Blood pressure comprises two numbers: the first number represents your systolic pressure, and the second number represents your diastolic pressure. Systolic blood pressure is the pressure exerted on your vessels when the heart muscles forcefully pump blood. Diastolic blood pressure is the pressure exerted when your heart is filling with blood and resting. As you can imagine, your systolic number will always be higher than your diastolic.
The “classic” blood pressure number is 120/80. But according to most sources, including the Centers for Disease Control and Prevention, 120/80 is the lowest number for people at risk for hypertension or prehypertension. The range for blood pressure is as follows:
Normal range = systolic < 120 mm Hg and diastolic < 80 mm Hg
Prehypertension = systolic between 120-139 mm Hg and diastolic between 80-89 mm Hg
Hypertension = systolic 140 mm Hg or higher and diastolic 90 mm Hg or higher
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Blood Pressure And Thyroid Medicine
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When To Contact A Doctor
It is important for a doctor to check a persons thyroid function if they are experiencing any of the previously mentioned symptoms, including palpitations, diarrhea, and excessive sweating.
If a person experiences any of the following symptoms after taking thyroid medication, they should contact their doctor immediately:
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Association Between Hypothyroidism And Hypertension
For most, high blood pressure, or hypertension is can be attributed to family history or lifestyle. For some, however, high blood pressure is the result of either an overactive or underactive thyroid.
Conversely, hypothyroidism occurs when the thyroid gland is underactive and does not produce enough hormones. Hypothyroidism can weaken the heart muscle and heart rate, reducing the hearts pumping capacity and increase the stiffening of blood-vessel walls. The combination of these changes can lead to hypertension.
If a thyroid disorder is the reason for high blood pressure, adjustments in diet and lifestyle wont resolve the problem and medications may not be effective. If a patients blood pressure does not respond to conventional treatment, a doctor can perform tests to see if the thyroid is the cause.However, hypertension is not a typical sign of hypothyroidism.
Hypothyroidism has been recognized as a cause of secondary hypertension. Previous studies on the prevalence of hypertension in subjects with hypothyroidism have demonstrated elevated blood pressure values. Increased peripheral vascular resistance and low cardiac output has been suggested to be the possible link between hypothyroidism and diastolic hypertension.
Basic causes of primary hypothyroidism are autoimmune, silent, postablative, goitrous, athyreotic and nonautoimmune , and subacute thyroiditis. Chronic autoimmune lymphocytic thyroiditis is the most common cause of thyroid gland dysfunction.
Effect Of Levothyroxine On Blood Pressure In Patients With Subclinical Hypothyroidism: A Systematic Review And Meta
- 1Department of Endocrinology, Affiliated Hospital of Yanan Medical University, Shaanxi, China
- 2Department of Endocrinology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
- 3Department of Cardiology, Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
Background: Patients with subclinical hypothyroidism have elevated blood pressure, but the effect of levothyroxine therapy on blood pressure among those patients is still unclear. This study aimed to assess whether LT4 therapy could reduce blood pressure in SCH patients through a systematic review and meta-analysis.
Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials , and Web of Science were searched. Randomized controlled trials assessing the effect of LT4 therapy on blood pressure or prospective follow-up studies comparing the blood pressure level before and after LT4 treatment were included, and the mean difference of systolic blood pressure or diastolic blood pressure was pooled using random-effect meta-analysis.
The findings suggest that LT4 replacement therapy can reduce blood pressure in SCH patients, which needs to be validated in more clinical trials with larger samples.
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