• Population: - TREND (n = 4420 individuals;
3189 available for present analysis)
• Exposures:
TSH full range; high TSH (> 3.0 mIU/L); low TSH (≤ 0.3 mIU/L); TSH within the reference range; 3,5-T2
• Outcomes
Retinal artery equivalent; retinal vein equivalent;
retinal arterio-venous ratio (AVR); AVR < 0.8
• Statistical methods
Linear and Poisson regression adjusted for age, sex, smoking, alcohol consumption, and intake of β-blockers
Robert Kempin
1, Till Ittermann
2, Marcus Dörr
3, Henry Völzke
2, Frank Tost
1, Clemens Jürgens
21
Department of Ophthalmology, University Medicine Greifswald, Germany
2
Institute for Community Medicine,
3Department of Internal Medicine B – Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases,
Hypothyroidism is Associated with Retinal Arteriolar Narrowing (RAN) in the
General Population
OBJECTIVES
MATERIALS AND METHODS
CONCLUSIONS
REFERENCES RESULTS
• Thyroid function is associated with hypertension, atherosclerosis, and inflammation (1 – 4)
• Retinal arteriolar narrowing (RAN)
− A marker of microvascular damage
− Accompanied by media thickening and development of sclerotic plaques
− Caused by long-term hypertension, atherosclerotic processes, and inflammation (5 – 8)
• No population-based data on the association between thyroid function and RAN
AIM: To investigate associations of TSH and 3,5-
diiodothyronine (3,5-T2) with RAN in population-based data
Figure 1. The fundus camera Figure 2. Image of the fundus
• Results substantiate evidence for an association between hypothyroidism and RAN
• Potential mechanisms explaining this association are long-term hypertension, atherosclerotic processes, and inflammation.
• Sex differences might be explained by sexual hormones and genetic differences, which might influence associations of thyroid hormones with blood pressure, atherosclerotic processes, and inflammation.
113. DOG-Kongress 1.-4.10.2015 Berlin
To the best of your knowledge - there is no conflict of interest.
Power-transformed TSH
Low TSH (≤0.3 mIU/L)
High TSH (>3.0 mIU/L)
TSH in reference range
Linear regression β (95%-CI) β (95%-CI) β (95%-CI) β (95%-CI)
Retinal arterio-venous ratio (AVR)
-0.028*
(-0.049; -0.007) -0.003
(-0.019; 0.012) -0.011
(-0.023; 0.002) -0.004
(-0.008; 0.001)
Retinal artery equivalent
-3.22
(-8.73; 2.30) -1.49
(-5.49; 2.51) -3.51*
(-6.73; -0.29) 0.24
(-0.88; 1.36)
Retinal vein equivalent 3.47
(-1.65; 8.60) -1.99
(-6.24; 2.25) -1.36
(-4.34; 2.25) 1.37*
(0.23; 2.50)
Poisson regression
Relative risk
(95%-CI)
Relative risk
(95%-CI) Relative risk
(95%-CI) Relative risk
(95%-CI)
Retinal AVR < 0.8
1.99*
(1.08; 3.65) 1.21
(0.71; 2.08) 1.40*
(1.02; 1.93) 1.09
(0.95; 1.24)
Table 1. Association between TSH and RAN
Figure 3. TSH and AVR<0.8 Figure 4. 3,5-T2 and AVR < 0.8
• Significant association between TSH full range and AVR
• Significant association between TSH full range and AVR <
0.8
• Significant association between high TSH and AVR < 0.8
Significant associations only in females (Figure 3)
• Significant association between 3,5-T2 and AVR < 0.8 (Figure 4)
• No significant associations for:
− Low TSH and AVR
− TSH in reference range and AVR
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2. Asvold BO, Bjoro T, Nilsen TI, Vatten LJ 2007 Association between blood pressure and serum thyroid-stimulating hormone concentration within the reference range: a population-based study. J Clin Endocrinol Metab 92:841-845.
3. Asvold BO, Bjoro T, Vatten LJ 2013 Associations of TSH levels within the reference range with future blood pressure and lipid concentrations: 11-year follow-up of the HUNT study. Eur J Endocrinol 169:73-82.
4. Ittermann T, Tiller D, Meisinger C, Agger C, Nauck M, Rettig R, Hofman A, Franco O, Joergensen T, Linneberg A, Witteman J, Greiser H, Werdan K, Doring A, Kluttig A, Stricker B, Volzke H 2013 High Serum TSH Levels are Associated with Current but not with Incident Hypertension. Thyroid.
5. Ikram MK, de Jong FJ, Vingerling JR, Witteman JC, Hofman A, Breteler MM, de Jong PT 2004 Are retinal arteriolar or venular diameters associated with markers for cardiovascular disorders? The Rotterdam Study. Invest Ophthalmol Vis Sci 45:2129-2134.
6. Sharrett AR, Hubbard LD, Cooper LS, Sorlie PD, Brothers RJ, Nieto FJ, Pinsky JL, Klein R 1999 Retinal arteriolar diameters and elevated blood pressure: the Atherosclerosis Risk in Communities Study. Am J Epidemiol 150:263-270.
7. Tso MO, Jampol LM 1982 Pathophysiology of hypertensive retinopathy. Ophthalmology 89:1132-1145.
8. Wong TY, Mitchell P 2004 Hypertensive retinopathy. N Engl J Med 351:2310-2317.
