Cardiac comorbidity in hypothyroidism: the effect of hormone replacement therapy
DOI:
https://doi.org/10.21638/spbu11.2024.301Abstract
The study of the features of the course of cardiovascular pathology against the background of other diseases (comorbidity) is currently an urgent area. A little-studied association is the assessment of the effect of hypothyroidism on cardiovascular pathology, especially the
role of hormone replacement therapy. Nevertheless, hypothyroidism is quite common with arterial hypertension, coronary heart disease, and chronic heart failure. According to research, hypothyroidism is associated with impaired lipidogram parameters, deterioration of coronary blood flow parameters, increased blood pressure, fluid retention, decreased effectiveness of antihypertensive therapy, and a higher incidence of arrhythmias, in particular atrial fibrillation. There is evidence of an association of hypothyroidism with proinflammatory cytokines. According to prospective studies, patients with chronic heart failure have a higher incidence of deaths and cases of rehospitalization due to decompensation of chronic
heart failure. The current focus is the role of L-thyroxine in the course of cardiovascular diseases. There is evidence of a positive effect of L-thyroxine on lipid metabolism and the
frequency of arrhythmias. However, specific recommendations regarding safety criteria and optimal dosages for the management of patients with cardiovascular pathology have not been developed.
Keywords:
arterial hypertension, coronary heart disease, hypothyroidism, L-thyroxine
Downloads
Download data is not yet available.
References
Литература
Timmis A., Kazakiewicz D., Torbica A., Townsend N., Huculeci R., Aboyans V., Vardas P. Cardiovascular disease care and outcomes in West and South European countries // The Lancet Regional Health —Europe. 2023. Vol. 4, no. 33, 100718. https://doi.org/10.1016/j.lanepe.2023.100718
Mehta P. K., Quesada O., Al-Badri A., Fleg J. L., Volgman A. S., Pepine C. J., Merz C. N. B., Shaw L. J// International Journal of Cardiology. 2022. Vol. 348. P. 1–8. https://doi.org/10.1016/j.ijcard.2021.12.013
Malakar A. K., Choudhury D., Halder B., Paul P., Uddin A., Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics // Journal of Cellular Physiology. 2019. Vol. 234, no. 10. P. 16812–16823. https://doi.org/10.1002/jcp.28350
Ott C., Schmieder R. E. Diagnosis and treatment of arterial hypertension 2021 // Kidney International.2022. Vol. 101, no. 1. P. 36–46. https://doi.org/10.1016/j.kint.2021.09.026
Петунина Н. А., Трухин И. В., Трухина Л. В., Сизова Ж. М., Захарова В. Л. Cердечная недостаточность и сахарный диабет: взгляд на коморбидность // Сахарный диабет. 2019. Т. 22, № 1.С. 79–87.
Гусенбекова Д. Г. Гипотиреоз: значимые аспекты клиники, диагностики и лечения // Терапевт.2019. № 12. С. 63–68.
Бадриев З. Ф. С., Карсанова Е. М. Сниженная функция щитовидной железы и патогенез распространенных сердечно-метаболических нарушений // Интернаука. 2022. Т. 41, № 1. С. 48–49.
Вербовой А. Ф., Долгих Ю. А., Вербовая Н. И. Гипотиреоз — междисциплинарная проблема// РМЖ. Медицинское обозрение. 2022. Т. 6, № 9. С. 509–515.
Попова Е., Тиньков А., Якубовская А., Никоноров А. Механизм влияния тиреоидных гормонов на обмен холестерина // Врач. 2017. № 5. С. 66–69.
Berta E., Lengyel I., Halmi S., Zrínyi M., Erdei A., Harangi M., Páll D., Nagy E. V., Bodor M. Hypertension in Thyroid Disorders // Front. Endocrinol. (Lausanne). 2019. Vol. 10. P. 482–488. https://doi.org/10.3389/fendo.2019.00482
Шустов С. Б., Барсуков А. В., Аль-Язиди М. А. Особенности ремоделирования миокарда у пациентов с АГ в зависимости от степени среднесуточной вариабельности АД // Артериальная гипертензия. 2002. Т. 8, № 2. С. 31–37.
Kim J., Prasitlumkum N., Randhawa S., Banerjee D. Association between subclinical hypothyroidism and incident hypertension in women: a systematic review and meta-analysis // Journal of Clinical Medicine. 2021. Vol. 10, no. 15. P. 33–38. https://doi.org/10.3390/jcm10153318
Андреева Л. А., Панченкова Л. А., Трошина Е. А., Хамидова Х. А., Гагиева А. М. Субклинический гипотиреоз и эссенциальная артериальная гипертония: особенности суточной динамики артериальной жесткости у коморбидных больных // Consilium Medicum. 2019. Т. 21, № 4. С. 21–25. https://doi.org/10.26442/20751753.2019.4.190362
Gluvic Z. M., Zafirovic S. S., Obradovic M. M., Sudar-Milovanovic E. M., Rizzo M., Isenovic E. R. Hypothyroidism and Risk of Cardiovascular Disease // Current Pharmaceutical Design. 2022. Vol. 28,no. 25. P. 2065–2072. https://doi.org/10.2174/1381612828666220620160516
Кушербаева Е. Ш., Омарова Р. О., Нурмаханова Ж. М., Бедельбаева Г. Г. Течение артериальной гипертензии на фоне заболеваний щитовидной железы (обзор литературы) // Вестник КазНМУ.2014. № 1. C. 23–36.
Cкаржинская Н. С., Чесникова А. И., Сафроненко В. А. Особенности артериальной гипертензии у больных гипотиреозом, пути медикаментозной коррекции // Артериальная гипертензия. 2016. Т. 22, № 4. С. 401–413. https://doi.org/10.18705/1607-419x-2016-22-4-401-413
Волкова А. Р., Беркович О. А., Дора С. В., Дыгун О. Д. Субклинический гипотиреоз и риск артериальной гипертензии у больных ишемической болезнью сердца // Артериальная гипертензия.2015. Т. 21, № 4. С. 409–415. https://doi.org/10.18705/1607-419X-2015-21-4-409-415
Delitala A. P., Scuteri A., Maioli M., Mangatia P., Vilardi L., Erre G. L. Subclinical hypothyroidism and cardiovascular risk factors // Minerva Medica. 2019. Vol. 110, no. 6. Р. 530–545. https://doi.org/10.23736/S0026-4806.19.06292-X
Yu C. C., Jiun Y. C., Chen P. L., Sheng C. C., Yu M. Wu. Nonthyroidal illness syndrome and hypothyroidism in ischemic heart disease population: a systematic review and meta-analysis // The Journal of Clinical Endocrinology and Metabolism. 2020. Vol. 105, no. 8. dgaa310. https://doi.org/10.1210/clinem/dgaa310
Kong S. H, Yoon J. W., Kim S. Y. Subclinical hypothyroidism and coronary revascularization after coronary artery bypass grafting // The American Journal of Cardiology. 2018. Vol. 122, no. 11. P. 1862–1870. https://doi.org/10.1016/j.amjcard.2018.08.029
Мунир А. Р., Виджейрагхаван Г., Анкудинов А. С., Калягин А. Н. Оценка морфофункциональных параметров миокарда у пациентов с ишемической болезнью сердца на фоне первичного манифестного гипотиреоза // Комплексные проблемы сердечно-сосудистых заболеваний. 2020. Т. 9, № 3. С. 6–12. https://doi.org/10.17802/2306-1278-2020-9-3-6-12
Peixoto E. J., Bittencourt M. S., Staniak H. L. Thyrotropin and free thyroxine levels and coronary artery disease: cross-sectional analysis of the brazilian longitudinal study of adult health (ELSA-Brasil) // The Brazilian Journal of Medical and Biological Research. 2018. Vol. 51, no. 5. P. 71–96. https://doi.org/10.1590/1414-431X20177196
Araújo Brandão K. M., Rajão A. L., Azeredo Passos V. M. Subclinical thyroid dysfunction was not associated with cardiac arrhythmias in a cross-sectional analysis of the ELSA-Brasil study // Arquivos Brasileiros de Cardiologia. 2019. Vol. 112, no. 6. P. 758‒766. https://doi.org/10.5935/abc.20190037
Gong N., Gao C., Chen X. Endothelial function in patients with subclinical hypothyroidism: a meta-analysis // Hormone and Metabolic Research. 2019. Vol. 51, no. 11. P. 691‒702. https://doi.org/10.1055/a-1018-9564
Baumgartner C., Costa B., Collet T. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation circulation // Circulation. 2017. Vol. 136, no. 22.P. 2100–2116. https://doi.org/10.1161/CIRCULATIONAHA.117.028753
Marrakchi S., Kanoun F., Idriss S. Arrhythmia and thyroid dysfunction // Herz. 2015. Vol. 40, no. 2.P. 101–109. https://doi.org/10.1007/s00059-014-4123-0
Moon S., Kim M. J., Yu J. M., Yoo H. I., Park Y. J. Subclinical hypothyroidism and the risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies //Thyroid. 2018. Vol. 28, no. 9. P. 1101–1110. https://doi.org/10.1089/thy.2017.0414
Sahin E., Bektur E., Baycu C., Burukoglu Dönmez D., Kaygısız B. Hypothyroidism increases expression of sterile inflammation proteins in rat heart tissue // Archive of “Acta Endocrinologica (Bucharest)”. 2019. Vol. 5, no. 1. P. 39–45. https://doi.org/10.4183/aeb.2019.39
Летникова Ю. Б., Дробышева В. Р., Токмачев Р. Е., Овсянников Е. С., Токмачев Е. B., Черник Т. А. Влияние дисфункции щитовидной железы на течение хронической сердечной недостаточности у пожилых пациентов // Молодежный инновационный вестник. 2019. Т. 8, № 2. С. 87–88.
Pingitore A., Landi P., Taddei M. C. Triiodothironine levels for risk stratification of patients with chronic heart failure // The American Journal of Medicine. 2005. Vol. 118. P. 132–136.
Klein I. Endocrine disorders and cardiovascular disease // Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia, W.B. Saunders. P. 2051–2065.
Thayakaran R., Nicola J. A. Sainsbury C. Thyroid replacement therapy, thyroid stimulating hormone concentrations and long term health outcomes in patients with hypothyroidism: Longitudinal study// The BMJ. 2019. Vol. 336. P. 1488–1492. https://doi.org/10.1136/bmj. l4892
Maaten J. M., Damman K., Verhaar M. C. Connecting heart failure with preserved ejection fraction and renal dysfunction: The role of endothelial dysfunction and inflammation // European Journal of Heart Failure. 2016. Vol. 18. P. 588–598. https://doi.org/10.1002/ejhf.497
Rizzo C., Gioia M. I., Parisi G., Triggiani V., Iacoviello M. Dysthyroidism and chronic heart failure: pathophysiological mechanisms and therapeutic approaches // Advances in Experimental Medicine and Biology. 2018. Vol. 1067. P. 239–253. https://doi.org/10.1007/5584_2017_132
Hashemi M. M., Kosari E., Mansourian A. R. Serum levels of nitrite/nitrate, lipid profile and fasting plasma glucose and their associations in subclinical hypothyroid women before and after a two month treatment by levothyroxine // Romanian Journal of Internal Medicine. 2017. Vol. 55, no. 4. P. 205‒211.https://doi.org/10.1515/jjim-2017-0022
Анкудинов А. С., Калягин А. Н., Мунир А. Р., Виджейрагхаван Г. Влияние L-тироксина на липидный профиль пациентов с ишемической болезнью сердца на фоне гипотиреоза // Сибирское медицинское обозрение. 2020. № 2. С. 30–35. https://doi.org/10.20333/2500136-2020-2-30-35
Curotto G. J., Peressotti B., Machado R. A. Improvement in functional capacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism // Endocrinologia, diabetes, nutricion. 2013. Vol. 60, no. 8. P. 427–432. https://doi.org/10.1016/j.endonu.2013.01.013
Tott D. J., Rodondi N., Kearney P. M. TRUST study group (2017) thyroid hormone therapy for older adults with subclinical hypothyroidism // The New England Journal of Medicine. 2017. Vol. 376.P. 2534–2544. https://doi.org/10.1056/NEJMc1709989
Wändell P., Carlsson A. C., Sundquist J. Effect of levothyroxine treatment on incident dementia in adults with atrial fibrillation and hypothyroidism // Clinical Drug Investigation. 2019. Vol. 39, no. 2.P. 187–195. https://doi.org/10.1007/s40261-018-0740-3
Sue L. Y., Leung A. M. Levothyroxine for the treatment of subclinical hypothyroidism and cardiovascular disease // Front. Endocrinol. (Lausanne). 2020. Vol. 11. P. 588–591. https://doi.org/10.3389/fendo.2020.591588
References
Tadayon S., Wickramasinghe K., Townsend N. Examining trends in cardio-vascular disease mortality across Europe: how does the introduction of a new European Standard Population affect the description of the relative burden of cardiovascular dis-ease? Population Health Metrics, 2019, vol. 17, no. 1,pp. 6–9. https://doi.org/10.1186/s12963-019-0187-7
Mehta P. K., Quesada O., Al-Badri A., Fleg J. L., Volgman A. S., Pepine C. J., Merz C. N. B., Shaw L. J.Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease. International Journal of Cardiology, 2022, vol. 348, pp. 1–8. https://doi.org/10.1016/j.ijcard.2021.12.013
Malakar A. K., Choudhury D., Halder B., Paul P., Uddin A., Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. Journal of Cel-lular Physiology, 2019, vol. 234, no. 10, pp. 16812–16823. https://doi.org/10.1002/jcp.28350
Ott C., Schmieder R. E. Diagnosis and treatment of arte-rial hypertension 2021. Kidney International,2022, vol. 101, no. 1, pp. 36–46. https://doi.org/10.1016/j.kint.2021.09.026
Petunina N. A., Trukhin I. V., Trukhina L. V., Sizova Zh. M., Zakharova V. L. Heart failure and diabetes mellitus: insight into comorbidity. Diabetes mellitus, 2019, vol. 22, no. 1, pp. 79–87. (In Russian)
Gusenbekova D. G. Hypothyroidism: Significant aspects of the clinic, diagnosis and treatment. Therapist,2019, no. 12, pp. 63–68. (In Russian)
Badriev S. S., Karsanova E. M. Reduced thyroid function and pathogen-esis of common cardiovascular and metabolic disorders. Internauka, 2022, vol. 41, no. 1, pp. 48–49. (In Russian)
Verbovoy A. F., Dolgikh Yu. A., Verbovaya N. I. Hypothyroidism is an in-terdisciplinary problem.RMJ. Medical review, 2022, vol. 6, no. 9, pp. 509–515. (In Russian)
Popova Е., Tinkov A., Yakubovskaya A., Nikonorov A. The mechanism of thyroid hormone action on cholesterol metabolism. Doctor, 2017, no. 5. pp. 66–69. (In Russian)
Berta E., Lengyel I., Halmi S., Zrínyi M., Erdei A., Harangi M., Páll D., Nagy E. V., Bodor M. Hypertension in Thyroid Disorders. Front. Endo-crinol. (Lausanne), 2019, vol. 10, pp. 482–488. https://doi.org/10.3389/fendo.2019.00482
Shustov S. B., Barsukov A. V., Al-Yazidi M. A. Features of myocardial remodeling in patients with hypertension depending on the degree of average daily blood pressure variability. Arterial hypertension, 2002, vol. 8, no. 2, pp. 31–37. (In Russian)
Kim J., Prasitlumkum N., Randhawa S., Banerjee D. Association between subclinical hypothyroidism and incident hypertension in women: A systematic review and meta-analysis. Journal of Clinical Medicine, 2021, vol. 10, no. 15, pp. 33–38. https://doi.org/10.3390/jcm10153318
Andreeva L. A., Panchenkova L. A., Troshina E. A., Khamidova Kh. A., Gagieva A. M. Subclinical hypothyroidism and essential arterial hypertension: Features of the daily profiles of arterial stiffness in comorbid patients. Consilium Medi-cum, 2019, vol. 21, no. 4, pp. 21–25. https://doi.org/10.26442/2075 1753.2019.4.190362 (In Russian)
Gluvic Z. M., Zafirovic S. S., Obradovic M. M., Sudar-Milovanovic E. M., Rizzo M., Isenovic E. R. Hypothyroidism and risk of coardiovascular disease. Current Pharmaceutical Design, 2022, vol. 28, no. 25,pp. 2065–2072. https://doi.org/10.2174/1381612828666220620160516
Kusherbayeva E. Sh., Omarova R. O., Nurmakhanova J. M., Bedelbayeva G. G. The course of arterial hypertension against the background of thyroid diseases (litera-ture review). Bulletin of KazNMU,2014, no. 1, pp. 23–36. (In Russian)
Skarzhinskaya N. S., Chesnikova A. I., Safronenko V. A. Arterial hyperten-sion in patients with hypothyroidism, management strategies. Arterial Hypotension, 2016, vol. 22, no. 4, pp. 401–413. https://doi.org/10.18705/1607-419x-2016-22-4-401-413. (In Russian)
Volkova A. R., Berkovich O. A., Dora S. V., Dygun O. D. Subclinical hypo-thyroidism and hypertension risk in patients with coronary artery disease. Arterial Hypertension, 2015, vol. 21, no. 4, pp. 409–415. https://doi.org/10.18705/1607-419X-2015-21-4-409-415 (In Russian)
Delitala A. P., Scuteri A., Maioli M., Mangatia P., Vilardi L., Erre G. L. Sub-clinical hypothyroidism and cardiovascular risk factors. Minerva Medica, 2019, vol. 110, no. 6, pp. 530–545. https://doi.org/10.23736/S0026-4806.19.06292-X
Yu C. C., Jiun Y. C., Chen P. L., Sheng C. C., Yu M. Wu. Nonthyroidal illness syndrome and hypothyroidism in ischemic heart disease population: A systematic review and meta-analysis. The Journal of Clinical Endocrinology and Metabolism, 2020, vol. 105, no. 8, dgaa310. https://doi.org/10.1210/clinem/dgaa310
Kong S. H. , Yoon J. W., Kim S. Y. Subclinical hypothyroidism and coronary revascularization after coronary artery bypass grafting. The American Journal of Car-diology, 2018, vol. 122, no. 11, pp. 1862–1870. https://doi.org/10.1016/j.amjcard.2018.08.029
Muneer A. R., Vijaraghavan G., Ankudinov A. S., Kalyagin A. N. Assess-ment of morphological and functional parameters of myocardium in patients with coronary artery disease and overt primary hypothyroidism. Complex Issues of Cardiovascular Diseases, 2020, vol. 9, no. 3, pp. 6–12. https://doi.org/10.17802/2306-1278-2020-9-3-6-12 (In Russian)
Peixoto E. J., Bittencourt M. S., Staniak H. L. Thyrotropin and free thyrox-ine levels and coronary artery disease: Cross-sectional analysis of the brazilian longitudi-nal study of adult health (ELSABrasil).The Brazilian Journal of Medical and Biological Research, 2018, vol. 51, no. 5, pp. 71–96. https://doi.org/10.1590/1414-431X20177196
Araújo Brandão K. M., Rajão A. L., Azeredo Passos V. M. Subclinical thy-roid dysfunction was not associated with cardiac arrhythmias in a cross-sectional analysis of the ELSA-Brasil study. Arquivos Brasileiros de Cardiologia, 2019, vol. 112, no. 6, pp. 758‒766. https://doi.org/10.5935/abc.20190037
Gong N., Gao C., Chen X. Endothelial function in patients with subclinical hypothyroidism:A meta-analysis. Hormone and Metabolic Research, 2019, vol. 51, no. 11, pp. 691‒702. https://doi.org/10.1055/a-1018-9564
Baumgartner C., Costa B., Collet T. Thyroid function within the normal range, subclinical hypothyroidism, and the risk of atrial fibrillation circulation. Circu-lation, 2017, vol. 136, no. 22, pp. 2100–2116.https://doi.org/10.1161/CIRCULATIONAHA.117.028753
Marrakchi S., Kanoun F., Idriss S. Arrhythmia and thyroid dysfunction. Herz, 2015, vol. 40, no. 2,pp. 101–109. https://doi.org/10.1007/s00059-014-4123-0
Moon S., Kim M. J., Yu J. M., Yoo H. I., Park Y. J. Subclinical hypothyroidism and the risk of cardiovascular disease and all-cause mortality: A meta-analysis of pro-spective cohort studies. Thyroid, 2018, vol. 28, no. 9, pp. 1101–1110. https://doi.org/10.1089/thy.2017.0414
Sahin E., Bektur E., Baycu C., Burukoglu Dönmez D., Kaygısız B. Hypothy-roidism increases expression of sterile inflammation proteins in rat heart tissue. Archive of “Acta Endocrinologica (Bucharest)”,2019, vol. 5, no. 1, pp. 39–45. https://doi.org/10.4183/aeb.2019.39
Letnikova Yu. B., Drobysheva V. R., Tokmachev R. E., Ovsyannikov E. S., Tokmachev E. B., Chernik T. A. The effect of thyroid dysfunction on the course of chronic heart failure in elderly patients. Molodezhny Innovatsionny Vestnik, 2019, vol. 8, no. 2, pp. 87–88. (In Russian)
Pingitore A., Landi P., Taddei M. C. Triiodothironine levels for risk stratifica-tion of patients with chronic heart failure. The American Journal of Medicine, 2005, vol. 118, pp. 132–136.
Klein I. Endocrine disorders and cardiovascular disease. Braunwald’s Heart Disease: A Textbook ofCardiovascular Medicine. Philadelphia, W.B. Saunders, pp. 2051–2065.
Thayakaran R., Nicola J. A., Sainsbury C. Thyroid replacement therapy, thyroid stimulating hormone concentrations and long term health outcomes in patients with hypothyroidism: Longitudinal study.The BMJ, 2019, vol. 336, pp. 1488–1492. https://doi.org/10.1136/bmj. l4892
Maaten J. M., Damman K., Verhaar M. C. Connecting heart failure with preserved ejection fraction and renal dysfunction: The role of endothelial dysfunction and inflammation. European Journal of Heart Failure, 2016, vol. 18, pp. 588–598. https://doi.org/10.1002/ejhf.497
Rizzo C., Gioia M. I., Parisi G., Triggiani V., Iacoviello M. Dysthyroidism and chronic heart failure: Pathophysiological mechanisms and therapeutic approach-es. Advances in Experimental Medicine and Biology, 2018, vol. 1067, pp. 239–253. https://doi.org/10.1007/5584_2017_132
Hashemi M. M., Kosari E., Mansourian A. R. Serum levels of ni-trite/nitrate, lipid profile and fasting plasma glucose and their associations in subclinical hypothyroid women before and after a two month treatment by levothyroxine. Romanian Journal of Internal Medicine, 2017, vol. 55, no. 4, pp. 205‒211.https://doi.org/10.1515/jjim-2017-0022
Ankudinov A. S., KalyaginА. N., Muneer A. R., Vijayaraghavan G. L-thyroxine infl uence on lipid profile of patients with ischemic heart disease on the back-ground of hypothyroidism. Siberian Medical Review, 2020, no. 2, pp. 30–35. https://doi.org/10.20333/2500136-2020-2-30-35 (In Russian)
Curotto G. J., Peressotti B., Machado R. A. Improvement in functional ca-pacity after levothyroxine treatment in patients with chronic heart failure and subclinical hypothyroidism. Endocrinologia, diabetes, nutricion, 2013, vol. 60, no. 8, pp. 427–432. https://doi.org/10.1016/j.endonu.2013.01.013
Tott D. J., Rodondi N., Kearney P. M. TRUST study group (2017) thyroid hormone therapy for older adults with subclinical hypothyroidism. The New England Journal of Medicine, 2017, vol. 376,pp. 2534–2544. https://doi.org/10.1056/NEJMc1709989
Wändell P., Carlsson A. C., Sundquist J. Effect of levothyroxine treatment on incident dementia in adults with atrial fibrillation and hypothyroidism. Clinical Drug Investigation, 2019, vol. 39, no. 2,pp. 187–195. https://doi.org/10.1007/s40261-018-0740-3
Sue L. Y., Leung A. M. Levothyroxine for the treatment of subclinical hypo-thyroidism and cardiovascular disease. Front. Endocrinol. (Lausanne), 2020, vol. 11, pp. 588–591. https://doi.org/10.3389/fendo.2020.591588
Downloads
Published
2025-01-22
How to Cite
Sumin, A., Ankudinov, A., & Rahaman , A. M. (2025). Cardiac comorbidity in hypothyroidism: the effect of hormone replacement therapy. Vestnik of Saint Petersburg University. Medicine, 19(3), 194–204. https://doi.org/10.21638/spbu11.2024.301
Issue
Section
Internal medicine
License
Articles of "Vestnik of Saint Petersburg University. Medicine" are open access distributed under the terms of the License Agreement with Saint Petersburg State University, which permits to the authors unrestricted distribution and self-archiving free of charge.
