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제목	Thyroid Hormone Replacement Decreases Cardiovascular Events in Diabetic Nephropathy Patients with Subclinical Hypothyroidism
저자	Changhwan Seo* 1, Misol Lee1, Min-Uk Cha1, Hyoungnae Kim1, Seohyun Park1, Hae-Ryong Yun1, Su-Young Jung1, Jong Hyun Jhee1, Youn Kyung Kee1, Chang-Yun Yoon1, Young Eun Kwon1, Seung Hyeok Han1, Tae-Hyun Yoo1, Shin-Wook Kang1, Jung Tak Park1
출판정보	2016; 2016(1):
키워드	cardiovascular disease, diabetic nephropathy, Subclinical hypothyroidism, Thyroid hormone replacement therapy
초록	Background: Patients with diabetic nephropathy are at a risk of developing cardiovascular complications. However, current strategies preventing these complications are limited. Recent studies have shown that subclinical hypothyroidism is associated with adverse renal and cardiovascular outcomes in both general population and patients with chronic kidney disease. Thyroid hormone replacement therapy (THRT) in patients with subclinical hypothyroidism has been found to improve the cardiovascular outcome in general population. However, whether commencing THRT in patients with diabetic nephropathy would benefit outcome is not yet known. Therefore, the clinical efficacy of THRT on clinical outcomes was evaluated in diabetic nephropathy patients with subclinical hypothyroidism. Methods: Diabetic nephropathy patients with subclinical hypothyroidism who were treated at Yonsei University Health System from 2000 to 2015 were enrolled for evaluation. Subclinical hypothyroidism was defined as normal free thyroxine with elevated thyroid stimulating hormone (TSH) levels. THRT was defined as thyroid hormone replacement for at least 60 days during the follow up period. Patients were divided into groups who underwent THRT or not. The primary outcomes were all-cause mortality and major cardiovascular events. Major cardiovascular events included myocardial infarction, ischemic stroke, and peripheral vascular disease. The patients were followed-up until death or 2015. Results: A total of 257 patients were evaluated. The mean age was 65.6±12.5 years, and 126 patients (49.0%) were male. The THRT group consisted of 83 (32.3%) patients. The THRT group showed significantly higher TSH levels (7.10±1.53 vs 6.16±1.21 μIU/mL, P < 0.001) and lower fasting plasma glucose (123.4±33.4 vs 142.9±62.5 mg/dL, P = 0.001) levels compared to the non-THRT group. During a mean follow up duration of 38.0±29.2 months, 21 patients died and major cardiovascular events were observed in 98 patients. Multiple Cox analysis revealed that THRT was independently associated with a decreased risk of major cardiovascular events (hazard ratio [HR], 0.558; 95% confidence interval [CI], 0.332-0.939, P = 0.028) even after adjustments were made for confounding factors. However, a clear relationship between THRT and all-cause mortality was not found (HR, 1.833; 95% CI, 0.440-7.642, P = 0.406). Conclusion: These findings suggest that THRT could decrease the risk of cardiovascular complications in diabetic nephropathy patients with subclinical hypothyroidism. Further clinical trials examining the effect of THRT in these patients would be needed.
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