Subclinical and Overt Thyroid Dysfunction and Risk of All-Cause Mortality and Cardiovascular Events: A Large Population Study

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Abstract

Context:

Thyroid dysfunction has been associated with both increased all-cause and cardiovascular mortality, but limited data are available on mild thyroid dysfunction and cause-specific mortality.

Objective:

The objective of the study was to examine the risk of all-cause mortality, major adverse cardiovascular events (MACEs), and cause-specific events in subjects with overt and subclinical thyroid dysfunction.

Design:

This was a retrospective cohort study.

Setting and Participants:

Participants in the study were subjects who underwent thyroid blood tests, without prior thyroid disease, consulting their general practitioner in 2000–2009 in Copenhagen, Denmark.

Main Outcome Measure:

All-cause mortality, MACEs, and cause-specific events identified in nationwide registries were measured.

Results:

A total of 47 327 (8.4%) deaths occurred among 563 700 included subjects [mean age 48.6 (SD ±18.2) y; 39% males]. All-cause mortality was increased in overt and subclinical hyperthyroidism [age adjusted incidence rates of 16 and 15 per 1000 person-years, respectively; incidence rate ratios (IRRs) 1.25 [95% confidence interval (CI) 1.15–1.36] and 1.23 (95% CI 1.16–1.30)] compared with euthyroid (incidence rate of 12 per 1000 person-years). Risk of MACEs was elevated in overt and subclinical hyperthyroidism [IRRs 1.16 (95% CI 1.05–1.27) and 1.09 (95% CI 1.02–1.16)] driven by heart failure [IRRs 1.14 (95% CI 0.99–1.32) and 1.20 (95% CI 1.10–1.31)]. A reduction of all-cause mortality was observed in subclinical hypothyroidism with TSH of 5–10 mIU/L [IRR 0.92 (95% CI 0.86–0.98)].

Conclusions:

Heart failure is the leading cause of an increased cardiovascular mortality in both overt and subclinical hyperthyroidism. Subclinical hypothyroidism with TSH 5–10 mIU/L might be associated with a lower risk of all-cause mortality.

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