Faculty of Medicine

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    Influence of the Subclinical Hypothyroidism on the Left Ventricular Systolic and Diastolic Function (pilot study)
    (OMICS Publishing Group, 2014)
    Velkoska Nakova, Valentina
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    Introduction: The clinically manifested hypothyroidism is associated with systolic and diastolic dysfunction. Studies investigating the left ventricular function in subclinical hypothyroidism (ScH) have shown controversial results. The aim of the study was to assess whether ScH is associated with the left ventricular systolic and diastolic dysfunction. Material and methods: Seventeen consecutive patients with newly diagnosed ScH and 20 healthy euthyroid patients as controls were analyzed. The two groups were appropriate by: age, sex, and body mass index. Laboratory analyses were performed in all patients - determination of TSH, free thyroxin (FT4), free triijodothyronine (FT3), antibodies directed to thyroid peroxidase (TPOAb) and antitiroglobulin antibodies (TgAb), and the assessment of left ventricular systolic and diastolic function by M-mode, two-dimensional echocardiography, pulse, continuous and color-Doppler, advanced echocardiographic modalities Tissue Doppler (TDI) and two-dimensional speckle tracking. Results: ScH patients had statistically significant lower ejection fraction, smaller ratio s/d (where s is the systolic velocity and d is the diastolic velocity through the pulmonary veins) and lower negative longitudinal global strain compared with the control group (62.1 ± 2.1 vs. 58.7 ± 6.2%, p<0.05, 1.27 ± 0.12 vs. 1.06 ± 0.20, p<0.001, -0.21 ± 0.01 versus -0.19 ± 0.01%, p<0.05, respectively). There was a statistically significant negative correlation of TSH with s/d and S/ TDI (r = 0.43 and r = 0.26, p<0.05, respectively). There was a statistically significant negative correlation of free thyroxine with myocardial performance index (r = -0.17, p<0.05), and a positive correlatin with s/d (r =0.48, p<0.05). Conclusion: ScH was associated with a statistically significant reduction in global systolic and global longitudinal systolic function of the left ventricle.
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    Does mild form of subclinical hypothyroidism needs treatment?
    (Bioscientifica, 2022-08-17)
    Velkoska Nakova, Valentina
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    Stevchevska Gjorgjievska, Aleksandra
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    Background Overt hypothyroidisms warrants L-T4 treatment, but treatment in subclinical hypothyroidism (ScH), especially in mild form of ScH (TSH between 4,2-10mU/l and normal free thyroxine) is unknown. Objectives To compare the presence of risk factors for atherosclerosis in patients with mild form of ScH to euthyroid subjects. Methods Prospectively 67 consecutive patients with newly diagnosed ScH, and 30 healthy subjects were recruited from the outpatient department of University clinic of endocrinology in Skopje, R. of N. Macedonia. Measurement of thyroid hormones, thyroid antibodies, blood pressure, lipids, and carotid intima media thickness (CIMT) were performed in all patients. Results Mean TSH value in ScH group was 8.71G1,9 mU/l. TSH value above 7mU/l was associated and positively correlated with symptoms of hypothyroidism. Prevalence of hypertension in ScH group was higher than the control group (35.4% vs. 13.3%, PZ0,03), with a 3.5 times higher risk for hypertension (ORZ 3,5 95%CI 1,1 – 11,4). In patients with mild form of SCH statistical significant difference in percentages of patients with arterial hypertension, hypertriglyceridemia, and values of total cholesterol/HDL-C and LDL/HDL above upper reference value were found (33.9 vs. 13.3%, 33.9 vs. 10%, 26.5 vs. 6.9%, 30.6% vs. 10.3%, respectively P ! 0.05). Mean CIMT was statistically significantly higher in ScH patients than the control group (0.61 G 0.1 vs. 0,56 G 0,1 mm, PZ0.03), but not different between the mild form of ScH and control group (PZ 0.08). Positive thyroid antibodies in the ScH group have no statistically significant influence on the CIMT. Conclusions In a small study, mild form of ScH was associated with higher risk for atherosclerosis, so these patients may benefit with L-T4 treatment.