Hypothyroidism and Cardiovascular Risk IV
The elevation of homocysteine is due to impaired renal clearance and alteration of thyroid hormones on the metabolism of folic acid.
In contrast, the subclinical hypothyroidism is not associated with hyperhomocysteinemia.
C-reactive protein (CRP) is an acute phase protein that circulates in higher concentrations in various acute and chronic diseases.
CRP levels are significantly elevated in clinical and subclinical thyroid problems.
There seems to be an increased risk of thrombosis that may precipitate myocardial infarction in mild hypothyroidism, and hemorrhage propensity during intense hypothyroidism.
It has been observed in different studies decreased fibrinolytic activity with D-dimer levels, increased activity of antiplasmin-2 and higher levels of tissue plasminogen activator.
Although hypothyroidism does not appear to cause insulin resistance, low levels of thyroid hormones can amplify a greater increase in cardiovascular risk associated with insulin resistance, the normal TSH levels are high, and higher LDL cholesterol.
The hypermetabolic state of hypothyroidism reduces peripheral O2 usage, cardiac work with bradycardia and decrease of myocardial contractility.
Thyroid hormones accelerate tissue calorigenesis, exert a positive chronotropic and inotropic effect on the heart leading to consider the possibility that replacement therapy may worsen myocardial ischemia, since there is impairment of coronary vasodilation in hypothyroid patients.
There are anecdotal reports of radiation ablation for the treatment of intractable angina with improved anginal symptoms by 76%.
Cardiac surgery need not be delayed for thyroid hormone replacement.
Percutaneous transluminal coronary angioplasty is an attractive alternative to surgery for aortocoronary bypasses in patients at high surgical risk due to associated medical conditions such as hypothyroidism.
The evolution post-angioplasty in patients with hypothyroidism have no differences between hypo-and euthyroid patients.
When compared with aortocoronary bypass surgery outcomes in hypothyroid patients is better with angioplasty.
Subclinical hypothyroidism does not seem to be a risk factor as procedural failure of coronary angioplasty and is an option with low morbidity in patients with hypothyroidism who require coronary revascularization.
It can be concluded that hypothyroidism predisposes patients to increased cardiovascular risk and treatment with levothyroxine can help reduce this risk by having the patients a better quality of life and lower morbidity and mortality.
Although it is a clear need to treat patients with overt hypothyroidism, levothyroxine treatment for people with subclinical hypothyroidism even cause much controversy because although on the one hand there are damages attributable to the increase in TSH, the lack of symptoms as well as long-term treatment and side effects make it difficult for both the physician and the patient reach an agreement on the need for its use.
In contrast, the subclinical hypothyroidism is not associated with hyperhomocysteinemia.
C-reactive protein (CRP) is an acute phase protein that circulates in higher concentrations in various acute and chronic diseases.
CRP levels are significantly elevated in clinical and subclinical thyroid problems.
There seems to be an increased risk of thrombosis that may precipitate myocardial infarction in mild hypothyroidism, and hemorrhage propensity during intense hypothyroidism.
It has been observed in different studies decreased fibrinolytic activity with D-dimer levels, increased activity of antiplasmin-2 and higher levels of tissue plasminogen activator.
Although hypothyroidism does not appear to cause insulin resistance, low levels of thyroid hormones can amplify a greater increase in cardiovascular risk associated with insulin resistance, the normal TSH levels are high, and higher LDL cholesterol.
The hypermetabolic state of hypothyroidism reduces peripheral O2 usage, cardiac work with bradycardia and decrease of myocardial contractility.
Thyroid hormones accelerate tissue calorigenesis, exert a positive chronotropic and inotropic effect on the heart leading to consider the possibility that replacement therapy may worsen myocardial ischemia, since there is impairment of coronary vasodilation in hypothyroid patients.
There are anecdotal reports of radiation ablation for the treatment of intractable angina with improved anginal symptoms by 76%.
Cardiac surgery need not be delayed for thyroid hormone replacement.
Percutaneous transluminal coronary angioplasty is an attractive alternative to surgery for aortocoronary bypasses in patients at high surgical risk due to associated medical conditions such as hypothyroidism.
The evolution post-angioplasty in patients with hypothyroidism have no differences between hypo-and euthyroid patients.
When compared with aortocoronary bypass surgery outcomes in hypothyroid patients is better with angioplasty.
Subclinical hypothyroidism does not seem to be a risk factor as procedural failure of coronary angioplasty and is an option with low morbidity in patients with hypothyroidism who require coronary revascularization.
It can be concluded that hypothyroidism predisposes patients to increased cardiovascular risk and treatment with levothyroxine can help reduce this risk by having the patients a better quality of life and lower morbidity and mortality.
Although it is a clear need to treat patients with overt hypothyroidism, levothyroxine treatment for people with subclinical hypothyroidism even cause much controversy because although on the one hand there are damages attributable to the increase in TSH, the lack of symptoms as well as long-term treatment and side effects make it difficult for both the physician and the patient reach an agreement on the need for its use.
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