The Two Faces of Janus: Why Thyrotropin as a Cardiovascular Risk Factor May Be an Ambiguous Target

Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but o...

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Bibliographic Details
Published in:Frontiers in endocrinology (Lausanne) 2020-10, Vol.11, p.542710-542710
Main Authors: Dietrich, Johannes Wolfgang, Hoermann, Rudolf, Midgley, John E M, Bergen, Friederike, Müller, Patrick
Format: Article
Language:English
Subjects:
Allostasis
allostatic load
Cardiovascular Diseases - blood
Endocrinology
Homeostasis
Humans
malignant arrhythmia
Risk Factors
Stress Disorders, Post-Traumatic - blood
subclinical hypothyroidism
sudden cardiac death
thyroid homeostasis
Thyroid Hormones - blood
thyrotropin
Thyrotropin - blood
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Summary:Elevated concentrations of free thyroid hormones are established cardiovascular risk factors, but the association of thyrotropin (TSH) levels to hard endpoints is less clear. This may, at least in part, ensue from the fact that TSH secretion depends not only on the supply with thyroid hormones but on multiple confounders including genetic traits, medication and allostatic load. Especially psychosocial stress is a still underappreciated factor that is able to adjust the set point of thyroid function. In order to improve our understanding of thyroid allostasis, we undertook a systematic meta-analysis of published studies on thyroid function in post-traumatic stress disorder (PTSD). Studies were identified MEDLINE/PubMed search and available references, and eligible were reports that included TSH or free thyroid hormone measurements in subjects with and without PTSD. Additionally, we re-analyzed data from the NHANES 2007/2008 cohort for a potential correlation of allostatic load and thyroid homeostasis. The available evidence from 13 included studies and 3386 euthyroid subjects supports a strong association of both PTSD and allostatic load to markers of thyroid function. Therefore, psychosocial stress may contribute to cardiovascular risk an increased set point of thyroid homeostasis, so that TSH concentrations may be increased for reasons other than subclinical hypothyroidism. This provides a strong perspective for a previously understudied psychoendocrine axis, and future studies should address this connection by incorporating indices of allostatic load, peripheral thyroid hormones and calculated parameters of thyroid homeostasis.
ISSN:1664-2392
1664-2392
DOI:10.3389/fendo.2020.542710