Linear and nonlinear analyses of heart rate variability following orthostatism in subclinical hypothyroidism

Medicine (Baltimore). 2019 Jan;98(4):e14140. doi: 10.1097/MD.0000000000014140.


Subclinical hypothyroidism (SCHypo) is associated with autonomic disturbances that can interfere in physiological responses. This study was designed to evaluate linear and nonlinear variables of heart rate variability (HRV) following postural change, comparing subjects with SCHypo to euthyroid subjects.HRV analyses were performed in 5-minute time series collected in the supine and standing positions from a subsample of 855 participants of the ELSA-Brasil study. The cardiac autonomic nervous function was evaluated by linear time and frequency domain analyses (SDNN, RMSSD, LFms, HFms, and LF/HF ratio) as well as by nonlinear symbolic dynamics (0, 1, and 2 V).After exclusions, 509 (92.0%) euthyroid and 44 (8.0%) SCHypo participants were eligible for analyses. At the baseline supine rest measurement, the 0 V symbolic pattern was higher (27.7 vs 25.4, P = .02) and 2 V was lower (18.0 vs 22.9, P = .02) than in the euthyroid group. Comparing the variation between positions, the 0 V pattern showed a lower delta in SCHypo than in Euthyroid subjects (8.0 vs 10.8%, P = .04).SCHypo presented lower sympathetic and parasympathetic tonus at rest and a blunted sympathetic response to active postural change, marked by reduced variation in the 0 V of symbolic analysis (SA). Additionally, it is suggested that SA of HR dynamics is an alternative and, possibly, a more sensitive method for cardiac autonomic assessment following orthostatism in this population.

MeSH terms

  • Autonomic Nervous System / physiopathology
  • Brazil
  • Cross-Sectional Studies
  • Dizziness / etiology
  • Dizziness / physiopathology*
  • Female
  • Heart Rate / physiology*
  • Humans
  • Hypothyroidism / complications
  • Hypothyroidism / physiopathology*
  • Linear Models
  • Male
  • Middle Aged
  • Nonlinear Dynamics
  • Posture / physiology