Subclinical Hyperthyroidism, Cardiovascular Disease and All-Cause Mortality: Insights from a Large Dutch Primary Care Cohort Study.

IF 6.7 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Thyroid Pub Date : 2026-05-08 DOI:10.1177/10507256261449444

Stan R Ursem, Raymond Noordam, Jesse M van den Berg, Anita Boelen, Petra Jm Elders, Wendy Pj den Elzen, Annemieke C Heijboer

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引用次数: 0

Abstract

Background: Subclinical hyperthyroidism (SHT) has been associated with adverse cardiovascular outcomes, but the magnitude and consistency of these risks, particularly across demographic subgroups, remain unclear.

Methods: We conducted a retrospective cohort study using general practitioner (GP) data from the PHARMO Data Network in the Netherlands (2012-2021). Patients with biochemically confirmed SHT (suppressed thyrotropin [TSH] with normal fT4; n = 11,163) were compared with a matched euthyroid reference group (n = 46,058) based on age, sex, and GP practice. Incidence of atherosclerotic complications, atrial fibrillation (AF), heart failure (HF), and all-cause mortality were assessed. Multivariable-adjusted Cox regression models estimated hazard ratios (HRs), adjusting for relevant confounders. Due to data limitations, information on smoking and alcohol use was not available, and medical history concerning comorbid conditions could only be assessed for the one-year period prior to cohort entry.

Results: SHT was associated with a significantly increased risk of AF (HR: 1.37, 95% CI: 1.22-1.55), particularly in those with TSH < 0.1 mU/L (HR: 1.60, 1.32-1.94) and in individuals aged 30-49 years (HR 1.88, 1.05-3.36). HF risk was modestly elevated overall (HR: 1.21, 1.04-1.40), with stronger effects in individuals aged 30-49 years (HR: 3.74, 1.52-9.24) and women (HR: 1.31, 1.10-1.56). All-cause mortality was higher in the SHT group (HR: 1.51, 1.38-1.64), especially in men (HR: 1.75, 1.50-2.05) and individuals aged 30-49 years (HR: 2.95, 1.73-5.04). The association with atherosclerotic complications was weak-to-modest (HR: 1.12, 1.00-1.24).

Conclusions: SHT is linked to increased risks of AF, HF, and all-cause mortality, with higher relative risks in younger patients. These findings challenge the traditional focus on older populations and underscore the need for individualized risk assessment in SHT.

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亚临床甲状腺功能亢进、心血管疾病和全因死亡率：来自荷兰一项大型初级保健队列研究的见解

背景：亚临床甲亢（SHT）与不良心血管结局相关，但这些风险的程度和一致性，特别是在人口亚组中，尚不清楚。方法：我们使用来自荷兰PHARMO数据网络（2012-2021）的全科医生（GP）数据进行了一项回顾性队列研究。根据年龄、性别和全科医生执业情况，将生化确诊的SHT（促甲状腺激素抑制但fT4正常，n = 11163）患者与匹配的甲状腺功能正常参照组（n = 46058）进行比较。评估动脉粥样硬化并发症、心房颤动（AF）、心力衰竭（HF）和全因死亡率的发生率。多变量校正Cox回归模型估计风险比（hr），调整相关混杂因素。由于数据限制，没有关于吸烟和饮酒的信息，并且只能评估队列进入前一年的合并症病史。结果：SHT与AF风险显著增加相关（HR: 1.37, 95% CI: 1.22-1.55），尤其是TSH < 0.1 mU/L的人群（HR: 1.60, 1.32-1.94）和30-49岁的人群（HR: 1.88, 1.05-3.36）。HF风险总体上略有升高（HR: 1.21, 1.04-1.40），其中30-49岁人群（HR: 3.74, 1.52-9.24）和女性（HR: 1.31, 1.10-1.56）的影响更大。SHT组的全因死亡率更高（HR: 1.51, 1.38-1.64），尤其是男性（HR: 1.75, 1.50-2.05）和30-49岁人群（HR: 2.95, 1.73-5.04）。与动脉粥样硬化并发症的相关性为弱至中等（HR: 1.12, 1.00-1.24）。结论：SHT与房颤、心衰和全因死亡风险增加有关，年轻患者的相对风险更高。这些发现挑战了传统上对老年人群的关注，并强调了对SHT进行个性化风险评估的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thyroid 医学-内分泌学与代谢

CiteScore

12.30

自引率

6.10%

发文量

195

审稿时长

6 months

期刊介绍： This authoritative journal program, including the monthly flagship journal Thyroid, Clinical Thyroidology® (monthly), and VideoEndocrinology™ (quarterly), delivers in-depth coverage on topics from clinical application and primary care, to the latest advances in diagnostic imaging and surgical techniques and technologies, designed to optimize patient care and outcomes. Thyroid is the leading, peer-reviewed resource for original articles, patient-focused reports, and translational research on thyroid cancer and all thyroid related diseases. The Journal delivers the latest findings on topics from primary care to clinical application, and is the exclusive source for the authoritative and updated American Thyroid Association (ATA) Guidelines for Managing Thyroid Disease.