Cardiovascular morbidity and mortality in patients in Wales, UK with resistance to thyroid hormone β (RTHβ): a linked-record cohort study
Authors' conclusion
We have documented reduced survival and increased cardiovascular morbidity in a cohort of patients with RTHβ for the first time. These outcomes might be driven by lifelong cardiac exposure to thyroid hormone excess; and effective therapies, targeting hormone resistant pathways, could potentially curtail this risk.
Study context
- Population
- Genetically confirmed patients with resistance to thyroid hormone β (RTHβ) followed in UK endocrine clinics, diagnosed Jan 1, 1997–Dec 31, 2019; Welsh Secure Anonymised Information Linkage (SAIL) Databankmatched cohort
- Participants
- 61 vs 2,750
- Exposure
- Patients with RTHβ vs matched population controls
- RTHβn = 61
- Controlsn = 2,750reference
- Outcome
- All-cause mortality and cardiovascular events
Methodological detailslinked-record, age-matched and sex-matched population controls, Kaplan-Meier and Cox regression models
- Linked-record
- Age-matched and sex-matched population controls
- Kaplan-Meier and Cox regression models
Main finding
As reported in the abstract
RTHβ vs ControlsHazard ratio (95% CI)
All-cause mortality
2.84(1.59–5.08)
HF
6.35(2.26–17.86)
MACE (CV death, acute MI, HF or stroke)
3.49(2.04–5.99)
- AF
- 10.56 (95% CI 4.72–23.63)
Observational data: associations, not effects.
Further findings
Age at first occurrence of any adverse event · earlier in RTHβ
difference 11
FT4 at diagnosis and mortality or major adverse cardiovascular events (MACE)
- Positive association between FT4 at diagnosis and mortality or MACE (cubic spline); FT4 ≥30 pmol/L conferred increased risk
Treatment and thyroid hormone excess
- Antithyroid drugs, surgery or RAI ablation, or thyroxine did not control thyroid hormone excess vs no intervention
Original publication
Cardiovascular morbidity and mortality in patients in Wales, UK with resistance to thyroid hormone β (RTHβ): a linked-record cohort study. Lancet Diabetes Endocrinol. Published 17 July 2023. doi:10.
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