RT Journal
A1 Razvi S, Pearce SS
T1 SUbclinical hypothyroidism and cardiovascular disease—reply
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2012
FD October 22
VO 172
IS 19
SP 1523
OP 1524
DO 10.1001/2013.jamainternmed.597
UL http://dx.doi.org/10.1001/2013.jamainternmed.597
AB 
We agree with Marfella et al that innate immune overactivity may explain the increased cardiovascular (CV) risk seen in subclinical hypothyroidism (SCH). However, several other possible mechanisms may also be responsible.1 An atherogenic lipid profile is seen in SCH that is improved with levothyroxine treatment.2 In addition, abnormal rheology,3 diastolic dysfunction,4 and impaired endothelial function2 are also seen in SCH, most of which are reversed with treatment. The mechanistic processes that underlie the high CV risk in SCH as well their effect on “hard” vascular outcomes need to be studied in a future randomized controlled trial. Furthermore, as noted in our recent analysis,5 the reasons for differences in outcomes of treatment in younger and older individuals with SCH also require study.