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In physiological condition, thyroid hormones exert on the heart and vessels several genomic and nongenomic mediated effects. The active form, triiodothyronine (T3), increases the cardiac inotropism and chronotropism and induces vasodilatation in the periphery determining the reduction of the systemic vascular resistance (SVR) [1]. In thyroid hormone deficiency, especially of T3, occurs the elevation of SVR, leading to systemic hypertension, followed by left ventricular (LV) hypertrophy (LVH) and diastolic dysfunction (DD) [2, 3]. On the other hand, hypothyroidism favours the occurrence of precocious and accelerated atherosclerosis, initiating degenerative processes in the arterial walls followed by the impairment of the elastic responsiveness of arterial walls, designated as arterial stiffness (AS) [4-6], and by the reduction of the elastic resistance opposed by the aorta against its distension, named aortic stiffness [7-9]. The fact that increased AS and reduced aortic distensibility (AoD) were detected even in subclinical hypothyroidism, is a subject of debate in many studies [7, 8]. All these parameters can be assessed non-invasively by various techniques. AS can be determined by pulse wave velocity (PWV) which is inversely associated with the vascular compliance[6]. PWV is the most well-validated method, with high accuracy, reproducibility and correlated with cardiovascular (CV) outcomes [10-12]. On the other hand, echocardiography offers the possibility to measure aortic diameters, to calculate several parameters that characterise aortic elasticity, LV mass index (LVMI) defining LVH and to accurately identify DD [13-15]. It remains the question if the substitution therapy with L-thyroxine could reverse those changes? There are data that describe a progressive improvement of AS and of AoD and the reduction of LVH and DD after the beginning of substitution therapy, which can be attributed to the beneficial effect exerted by L-thyroxine on the CV system [16]. The aim of this study is to assess, by means of echocardiography, the prevalence of AS and of impaired aortic elasticity in female patients with overt and subclinical hyperthyroidism in comparison with age-matched healthy controls as well as their relationship with the gravity of the thyroid dysfunction, defined by levels of thyroid stimulating hormone (TSH) and FT4. Another purpose is to evidence if these alterations are reversible under therapy with Lthyroxine.

Impact of Therapy with L-Thyroxine on the Evolution of Arterial and Aortic Stiffness in Female Patients with Overt and Subclinical Hypothyroidism