Thyroid Function and Mortality in Patients with Chronic Heart Failure

Sarfaroj Khan 


November 03, 2020


  • Thyroid dysfunction was associated with worse survival in patients with chronic heart failure (HF), but was not an independent predictor of mortality.

Why this matters

  • Subclinical thyroid dysfunction is very common in patients with chronic HF.

  • Studies reporting the association between thyroid dysfunction and outcomes in large populations of patients with HF have produced conflicting results.

Study design

  • This retrospective study included 2997 patients with HF with reduced ejection fraction (HFrEF) and 1995 patients with HF with normal ejection fraction (HFnEF).

  • Euthyroid state was defined as thyroid-stimulating hormone (TSH) level between 0.35 and 4.70 mIU/L, hypothyroid as TSH >4.70 mIU/L and hyperthyroid as TSH <0.35 mIU/L.

  • Primary outcome: all-cause mortality.

  • Funding: The Academy of Medical Sciences and the Wellcome Trust.

Key results

  • Overall, 4491 (90%) patients were euthyroid, 312 (6%) were hypothyroid and 189 (4%) were hyperthyroid.

  • In univariate analysis, both hypothyroid (HR, 1.25; 95% CI, 1.08-1.45) and hyperthyroid (HR, 1.21; 95% CI, 1.01-1.46) patients were at a higher risk of all-cause mortality vs euthyroid patients.

  • There was a U-shaped relation between TSH and mortality.

  • In patients with HFrEF, increasing TSH was associated with increased mortality in univariate analysis (HR, 1.02; 95% CI, 1.01-1.03), but the association disappeared in multivariate analysis.

  • In patients with HFnEF, a weak but significant association was seen between increasing TSH and mortality which persisted in multivariate analysis (HR, 1.02; 95% CI, 1.00-1.04; P=.02).

  • Increasing age, increasing N-terminal pro-B-type natriuretic peptide and higher New York Heart Association class were strongest predictors of mortality.


  • Retrospective design.


Samuel NA, Cuthbert JJ, Brown OI, Kazmi S, Cleland JGF, Rigby AS, Clark AL. Relation between Thyroid Function and Mortality in patients with Chronic Heart Failure. Am J Cardiol. 2020 Oct 25 [Epub ahead of print]. doi: 10.1016/j.amjcard.2020.10.034. PMID: 33115640 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.


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