Q J Med 2000; 93: 477-485
© 2000 Association of Physicians
Commentary papers |
The thyroid, blood flow and atheroma
Introduction
This paper aims to demonstrate how thyroid function and other conditions that affect blood flow influence the development of atheroma. Blood flow in larger vessels varies with the cardiac output. Blood flow in the capillaries is affected by viscosity changes. The mechanisms that affect the flow in large and small vessels may summate. Overt changes in thyroid function clearly affect blood flow, but are less apparent in subclinical hypothyroidism (SCH). SCH is defined as impairment of thyroid function associated with normal thyroxine (T4) and tri-iodothyronine (T3) hormone concentrations, but either a raised basal thyrotrophin (TSH) concentration or an exaggerated response of TSH to thyrotrophin-releasing hormone (TRH).
Three views have been held regarding SCH as a risk factor for coronary heart disease (CHD). Some workers have failed to find an association between the two conditions.1–4 A second view is that an association with CHD results from abnormal serum lipids found in
Physiology of blood flow
Pathology of blood flow
Impaired blood flow—cause or effect?
Distribution of atheroma
Altered blood flow
Thyroid status
Exercise
Obesity
Anaemia
Diabetes mellitus
Paget's disease (osteitis deformans)
Smoking
Geography
Seasonal variations in coronary heart disease
Effect of vasodilators on CHD
Alcohol
Nicotinic acid
Other vasodilator drugs
Viscosity
HDL and LDL cholesterol
Effect of endothelium on blood flow
Hypertension
Future action
Notes
References
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