Table 1.

Guidelines with Recommendations for Management of Thyroid Dysfunction Coexistent with Cardiovascular Disease

Condition	Recommendation
Atrial fibrillation	Thyroid testing for a first episode (4–7) and when ventricular rate is difficult to control (5,6)
	Beta-blocker to control ventricular rate when complicating thyrotoxicosis (5,8,9)
Heart failure	Thyroid testing at initial presentation (6)
Dilated cardiomyopathy	Thyroid testing at initial presentation (10)
Amiodarone use	Thyroid testing before, within 3 months of initiation, and every 3–6 months (8)
	Thyroid testing before, at 1 and 3 months after initiation, and every 3–6 months (9)
Subclinical hyperthyroidism	If cardiac risk factors or cardiac disease, treat if TSH persistently <0.1 mIU/L (8,9)
	If cardiac disease, consider treatment if TSH persistently 0.1–0.4 mIU/L (8,9)
Overt hypothyroidism	With known coronary artery disease, start low-dose levothyroxine and increase dose slowly
	If unable to tolerate full dose, additional measures to treat CVD are indicated (11)
Subclinical hypothyroidism	Treat all patients (12) or consider treatment (13) with TSH level persistently >10 mIU/L
	Consider treatment:  • For patients with TSH levels 4.5–10 mIU/L with ASCVD, heart failure, or associated risk factors for these diseases (13)  • For patients with TSH levels 4.5–10 mIU/L, for those patients younger than 65 years with increased cardiovascular risk (e.g., previous cardiovascular disease, diabetes, dyslipidemia, hypertension, metabolic syndrome), particularly with TSH level persistently >7 mIU/L (12)

ASCVD, atherosclerotic cardiovascular disease; CVD, cardiovascular disease; TSH, thyroid-stimulating hormone.