Hypertension And Increased Cardiovascular Risk In Overt Hyperthyroidism
Hyperthyroidism is accompanied by cardiovascular complications in a significant number of cases, leading to an increase in short-term morbidity and long-term morbidity and mortality. Brandt et al. found a significant 20% increase in mortality in patients with hyperthyroidism in their meta-analysis based on seven studies .
The excess of T3 leads to metabolic and hemodynamic changes: metabolic rate, cardiac preload, and ventricular contractility increases while systemic vascular resistance decreases, causing an increased cardiac output and hypertension, as discussed above.
The highest risk of coronary heart disease mortality and atrial fibrillation is noted when serum TSH is below 0.10 mIU/l .
Hemodynamic changes affect not only the left cardiac output, since pulmonary hypertension may also be present in patients with hyperthyroidism due to Graves-disease or nodular goiter . Pulmonary hypertension was found to be the most common complication in a study which investigated hyperthyroid patients by echocardiography . The prevalence of pulmonary hypertension was detected to be relatively high among hyperthyroid patients, varying between 36 and 65%, although mild and asymptomatic cases were found to be the most common .
Thyroid Hormone And Your Heart
It is well known that thyroid hormone influences your heart.
And, because your heart pumps blood throughout your body, any changes to your heart rate or force of contraction can also cause changes to your blood pressure.
We also know, from plenty of studies, that maintaining a healthy blood pressure is absolutely vital to leading a long life and avoiding complications such as stroke, end-organ damage, kidney failure, and heart disease.
Doctors go to great lengths to help manage blood pressure because of these negative side effects!
So, why then does taking thyroid medication cause high blood pressure in some situations?
It has to do with how thyroid hormone interacts with cardiac tissue .
In almost every cell in your body thyroid hormone works by entering into your cell and changing genetic transcription .
This process results in changes to your DNA which take weeks to kick in.
But in your heart cells, thyroid hormone activates receptors on a different part of the cell.
This means that the effects of thyroid hormone occur much faster when compared to the genetic changes that occur in other cells in your body.
Through this mechanism, thyroid hormone medication can potentially lead to elevated blood pressure even though you might feel great otherwise.
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.
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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
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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Too Little Or Too Much Of This Crucial Hormone Can Contribute To Heart Problems
Located at the base your throat, the butterfly-shaped thyroid gland releases hormones that affect every organ in your bodyespecially your heart. Thyroid hormone influences the force and speed of your heartbeat, your blood pressure, and your cholesterol level. As a result, a malfunctioning thyroid gland can cause problems that masquerade as heart disease or make existing heart disease worse.
An estimated 6% of people in the United States have thyroid disease. Most of themabout 80% have an underactive thyroid, or hypothyroidism. When thyroid levels drop, all the systems in the body slow down, triggering a range of symptoms that include fatigue, weight gain, cold intolerance, constipation, and dry skin. But these symptoms are very common in people as they grow older, including those with normal thyroid levels.
“More than half of people with normal thyroid function have symptoms of hypothyroidism,” says Dr. Jeffrey Garber, an endocrinologist at Harvard-affiliated Beth Israel Deaconess Medical Center and medical editor of the Harvard Special Health Report Thyroid Disease. In addition, some people over age 60 with low thyroid levels don’t have the classic symptoms. That’s why recognizing hypothyroidism can be particularly tricky, he adds. Certain factors make people more likely to have thyroid problems.
Experiences With High Blood Pressure And Hypothyroidism
A person with untreated hypothyroidism can experience high blood pressure because of the following:
- If your kidneys no longer filter waste when youre experiencing lower blood pressure, angiotensin is formed. When this happens, your blood pressure rises.
- If you have a T4 deficiency and your body does not react to the medication taken for this deficiency, then your body naturally raises your blood pressure in an attempt to correct this issue.
- A person with hypothyroidism often experiences cold hands and feet. This happens when your body cuts blood flow to the hands and feet to focus on the core of your body instead. Because of this, your blood pressure rises due to the blood being kept in smaller vessels of your body.
When you have a thyroid condition, it is extremely important to have your blood pressure checked regularly. If you normally check it at home, here is a chart to help you better understand exactly what the numbers mean.
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What Medication Can Be Taken To Relieve Arthritis Pain If I Have High Blood Pressure
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Reduced Blood Volume & Cardiac Output
Hypothyroid conditions frequently result in an overall decreased about of blood volume and related decreased cardiac output . This decreased blood volume triggers the kidneys to raise blood pressure.
Reduced blood volume paired with the decrease in available T3 explains the prevalence of diastolic hypertension in hypothyroid patients: lower blood volume results in less blood to pump around, so while the vessels are not as flexible, there is not as much blood being pushed per pump of the heart.
Systolic blood pressure increases, but not as much in relation to diastolic pressure increases. The constant pressure from the blood volume on further restricted vessels is revealed by the diastolic pressure. Over time, without adequate treatment for the hypothyroid condition, both numbers will continue to elevate.
Blood pressure is independent of TSH levels: actual thyroid hormone levels are the indicator. The mechanism for systolic hypertension in hypothyroid disease isnt quite understood, yet.
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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 .
Is Your Thyroid Causing Your High Blood Pressure
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.
An overactive thyroid, known as hyperthyroidism, is a condition where the thyroid gland produces too much of the thyroid hormone. When too much of this hormone is produced, the heart is forced to work harder than usual, which increases heart rate and raises blood pressure. Hyperthyroidism is the more common thyroid disorder that can cause hypertension.
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.
In cases where hypertension due to a thyroid disorder is diagnosed, medications or supplemental hormones can be prescribed to control the thyroid gland and better control blood pressure.
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Do Thyroid Problems Cause High Blood Pressure
Hyperthyroidism and hypothyroidism are two thyroid problems that can both cause high blood pressure, but the mechanism of how this happens differs. Hyperthyroidism causes high blood pressure by making the heart beat faster and work harder due to the increase in thyroid hormones. Hypothyroidism is thought to cause high blood pressure by weakening the heart muscles and increasing resistance in the blood vessels around the body.
Effects Of Thyroid Hormone On Your Blood Pressure
When you are hypothyroid you may need to take thyroid medication.
These medications contain thyroid hormones and are meant to supplement whatever thyroid hormone your body can produce naturally.
If your body can only produce 80% of whatever is normal thyroid hormone for you, then we try to give you back that other 20% so you can get as close to 100% as possible.
The problem is that sometimes you can actually get more than you need.
Imagine if your body produces 80% but we give you back 40%.
All of a sudden your body is getting 120% of whatever is considered normal for you.
This is when side effects such as heart palpitations and elevated blood pressure tend to kick in .
As you take too much thyroid medication your heart may start to beat faster and harder which results in an increase in blood pressure.
This effect is regulated through calcium channel pumps found on your cardiac cells .
The more thyroid hormone that you take the more these pumps will work, the higher your blood pressure will go, and the more symptomatic you may become.
The good news is that you can relatively easily modify your dose of thyroid medication to fix this problem.
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Hypertension In Overt Hypothyroidism
A high prevalence of diastolic hypertension had been found in patients above 50 years of age with overt hypothyroidism whose blood pressure was normalized after adequate thyroid hormone replacement therapy . However, hypothyroidism as a cause of hypertension is often overlooked. In an early study Saito et al. found a 3-fold higher prevalence of diastolic hypertension in hypothyroidism than in age-matched patients without thyroid disorder using the World Health Organization’s earlier used criteria for hypertension, namely blood pressure > 160/95 mmHg . According to the current ESC guidelines for the treatment of hypertension, in-office systolic blood pressure values 140 mmHg and/or diastolic blood pressure values 90 mmHg define hypertension based on evidence from multiple randomized clinical trials proving that treatment of patients with these BP values is beneficial .
Thyroid And High Blood Pressure
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Contents
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How Does Blood Pressure Work & What Is Hypertension
Blood pressure is the measurement of what kind of pressure is being put on your blood vessels . The top number in a blood pressure reading reveals the pressure on the walls of the vessels when the heart is pumping, systolic blood pressure.
The bottom number represents the pressure on the walls of the vessels when the heart is at rest or between beats, diastolic. Blood pressure acts diurnally, as well: higher during awake hours and lower while sleeping. Blood pressure readings consistently above 140/90 are considered hypertensive.
What Causes High Blood Pressure
Hypertension is a condition where the blood consistently exerts too much pressure on the artery walls around the body.
Blood pressure is determined by:
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The volume of blood pumped by the heart
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The condition of the heart valves
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How well the heart pumps
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Size and resistance of the arteries
The causes of high blood pressure can depend on whether it is a primary or secondary condition.
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Hypothyroidism And High Blood Pressure
âThe thyroid hormone has an effect on every organ system in the body. And in fact, the thyroid plays a crucial role in helping regulate some of our most vital functions, including heart rate, body temperature, and blood pressure. Therefore, it should be no surprise that when thyroid hormone levels are off, the entire body, and its most important functions, may be compromised. For this reason, people with an underactive thyroid often have symptoms that can affect the whole body. Here, we focus on high blood pressure and how an underactive thyroid influences this vital function.
Genetic Background Of Thyroid Function Affecting Blood Pressure
While a normal TSH and consequently fT4 and fT3 within the physiological range are essential in growth, differentiation and maintenance of adequate function of all human organs, several genetic defects have been evaluated and described in the route of thyroid hormone signaling during the past decade, including those with mutations in thyroid hormone transporters and receptors . According to novel studies, even minor changes in the thyroid hormone levels can affect bone mineral density , mental status , and can also lead to impaired metabolism , and increased cardiovascular risk . While the levels of the serum thyroid hormones show marked inter-individual variability, there is no significant intra-individual variability, as TSH values change very little during time . Based on these results a conclusion can be made that each individual has a unique thyroid set-point, defined by genetic and environmental factors such as iodine intake and smoking .
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