Context: Congenital hypothyroidism (CH) is the most prevalent endocrine disorder in the newborn and is routinely treated with life-long levothyroxine replacement therapy. Although several studies have demonstrated that such therapy may impact on the cardiovascular system, little is known with regard to the effects of long-term levothyroxine administration in patients with congenital hypothyroidism.

Objective: The aim of the current study was to evaluate whether long-term L-T4 replacement therapy in young adults with CH is associated with cardiovascular abnormalities.

Patients and methods: Thirty young adults with congenital hypothyroidism aged 18.1±0.2 years and 30 age and sex-matched controls underwent cardiac and carotid Doppler ultrasound and symptom-limited cardiopulmonary exercise testing. Hypothyroidism was diagnosed by neonatal screening and levothyroxine treatment was initiated within the first month of life and carefully adjusted to maintain TSH levels in the normal range and free thyroxine in the high-normal range.

Results: Compared with controls, hypothyroid patients exhibited left ventricular (LV) diastolic dysfunction, impaired exercise capacity, and increased intima-media thickness. At multiple regression analysis, the number of episodes of plasma TSH levels <0.5 mU/l and >4.0 mU/l from the age of 1 year onward and mean TSH plasma levels during puberty were independent predictors of diastolic filling and cardiopulmonary performance indexes (multiple r values: 0.61-0.75).

Conclusions: Long-term levothyroxine treatment in young adults with congenital hypothyroidism is associated with impaired diastolic function and exercise capacity, and increased intima-media thickness.