Suboptimal Levothyroxine Treatment is Associated with Increases in Mean Blood Pressure and Blood Pressure Variability
Authors' conclusion
Suboptimal LT4 treatment was associated with increases in mean BP and BPV, representing potential mediators in the pathway between suboptimal LT4 treatment and cardiovascular disease.
Study context
- Population
- Adult patients treated with levothyroxine (LT4) for hypothyroidism
- Participants
- 2,203 patients
- Exposure
- LT4 time above range (TAR) and time below range (TBR) (% time), associated with annual mean blood pressure (BP) and visit-to-visit blood pressure variability (BPV)
- Outcome
- Within-individual changes in annual mean SBP and DBP as a function of TAR (TSH >4.5 mIU/L) and TBR (TSH <0.4 mIU/L)
Methodological detailslinear mixed-effect modeling, adjusted for sociodemographics, baseline comorbidities, weight, LT4 dose, time, and year of study enrollment, Sensitivity analyses with wide in-range boundaries (TSH 0.1-10 mIU/L) and stratification by hypertension at baseline
- Linear mixed-effect modeling
- Adjusted for sociodemographics, baseline comorbidities, weight, LT4 dose, time, and year of study enrollment
- Sensitivity analyses with wide in-range boundaries (TSH 0.1-10 mIU/L) and stratification by hypertension at baseline
Main finding
As reported in the abstract
100% increase in TAR: annual mean SBP
+1.8 mmHg
P = .011
100% increase in TAR: annual mean diastolic blood pressure (DBP)
+1.0 mmHg
P = .024
100% increase in TBR: annual mean SBP
+2.7 mmHg
P = .004
100% increase in TBR: annual mean DBP
+1.3 mmHg
P = .034
Observational data: associations, not effects.
Further findings
Annual visit-to-visit diastolic BPV
- 100% TAR
- +0.67 mmHg, P = .009
- 100% TBR
- +0.85 mmHg, P = .020
Original publication
Suboptimal Levothyroxine Treatment is Associated with Increases in Mean Blood Pressure and Blood Pressure Variability. J Clin Endocrinol Metab. Published 17 December 2025. doi:10.
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