Decrease in carotid intima-media thickness in hypothyroid patients after normalization of thyroid function

Clin Endocrinol (Oxf). 2003 Nov;59(5):607-12. doi: 10.1046/j.1365-2265.2003.01893.x.


Objective: This case-control study was carried out to assess whether levothyroxine (L-T4) replacement might cause regression of the enhanced atherosclerosis seen in hypothyroid patients.

Patients and methods: Intima-media thickness (IMT) in the common carotid artery (CCA) was measured from digitalized still images taken during scanning by high-resolution ultrasonography as an indicator of early atherosclerosis. Thirty-five hypothyroid patients were examined for their CCA IMT before and 1 year after normalization of thyroid function by L-T4 replacement. As control, 35 healthy subjects were enrolled from among the participants in a local health-check programme conducted at the Osaka City University Hospital.

Results: Basal CCA IMT was significantly higher in hypothyroid patients [0.635 +/- 0.018 (mean +/- SE) mm] than in control subjects (0.559 +/- 0.021 mm, P < 0.005). After 1 year of euthyroidism, 34 out of 35 patients showed a significant decrease of CCA IMT, to 0.552 +/- 0.015 mm (P < 0.0001), a level comparable to normal controls. CCA IMT change was closely associated with basal levels of total cholesterol (r = -0.472, P= 0.0031), low-density lipoprotein (LDL) cholesterol (r = -0.441, P= 0.0076) and the total/HDL cholesterol ratio (r =-0.435, P= 0.0057), but not with any of the other variables measured except for age (r = -0.353, P= 0.0296).

Conclusions: This study demonstrated that L-T4 treatment might have the potential to reverse the progression of atherosclerosis in hypothyroid patients. Furthermore, it suggests that increased levels of LDL cholesterol and the total/HDL cholesterol ratio have an important role in the increased common carotid intima-media thickness in hypothyroid patients.

MeSH terms

  • Carotid Artery Diseases / blood
  • Carotid Artery Diseases / diagnostic imaging
  • Carotid Artery Diseases / etiology
  • Carotid Artery, Common / diagnostic imaging*
  • Case-Control Studies
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Female
  • Humans
  • Hypothyroidism / blood
  • Hypothyroidism / diagnostic imaging*
  • Hypothyroidism / drug therapy*
  • Image Processing, Computer-Assisted
  • Male
  • Middle Aged
  • Prospective Studies
  • Risk Factors
  • Thyroxine / therapeutic use*
  • Tunica Intima / diagnostic imaging*
  • Ultrasonography


  • Cholesterol, HDL
  • Cholesterol, LDL
  • Cholesterol
  • Thyroxine