Elevated TSH in Patients With Heart, Renal Failure Is Not Always Indicative of Thyroid Disorder

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Elevated levels of thyrotropin in patients with a history of chronic heart or renal failure may not always indicate thyroid disease.

After careful consideration, the Endocrine Society canceled its annual meeting (ENDO 2020), which was set to take place in San Francisco, California, from March 28 to 31, 2020, because of concerns regarding coronavirus disease 2019 (COVID-19). Research findings that were scheduled to be presented at the meeting have been published in a supplemental issue of the Journal of the Endocrine Society.

The society is hosting ENDO Online, a complimentary virtual event featuring on-demand and live programming, from June 8 to 22, 2020, to provide a platform for continued learning and research exhibition. For more information, visit the Endocrine Society’s website.

Elevated levels of thyrotropin (TSH) in patients with a history of chronic heart or renal failure may not always indicate thyroid disease, according to study findings intended to be presented at the annual meeting of the Endocrine Society (ENDO 2020).

Subclinical hypothyroidism is common in chronic heart or renal failure but it is not clear whether this occurs because of thyroid disease or isolated elevation of TSH levels. To examine this, researchers determined whether thyroid function was altered in patients hospitalized more than once for chronic heart or renal failure.

For their study, the researchers reviewed 90,199 medical records of patients hospitalized in nonsurgical wards between 2013 and 2016. Patients were included if they had TSH levels above the normal range, had free thyroxine levels in the normal range, and were rehospitalized within 6 months of the first hospitalization. Worsening of thyroid function was defined as an increase in TSH to >12 mU/L or initiation of levothyroxine treatment. Chronic heart and renal failure were determined based on reported diagnosis and drug treatment at the time of hospitalization.

Overall, 2116 hospitalizations met the inclusion criteria. The final analysis included 126 patients with ≥1 rehospitalization. Of these patients, 43 (34.1%) had chronic heart failure and 22 (17.5%) had chronic renal failure. Thyroid function had worsened in a total of 11 patients (8.7%) at subsequent rehospitalization, whereas TSH levels were normal in 81.4% of patients rehospitalized for heart failure and 86.4% of patients rehospitalized for renal failure. There was no association observed between worsening of thyroid function and heart or renal failure. Most incidences of worsening thyroid function were attributable to the initiation of levothyroxine treatment.

The researchers could not confirm whether initiation of levothyroxine treatment was the true cause of worsened thyroid function given the study’s retrospective nature, but concluded that in most cases, elevated TSH levels in patients hospitalized for chronic heart or renal failure may not necessarily indicate the presence of thyroid disease.


Bashkin A, Saleh WA, Ronen O. Subclinical hypothyroidism in hospitalized patients with chronic heart-failure or chronic renal-failure is most probably not due to thyroid disease. J Endocr Soc. 2020;4(suppl 1):SUN-409.

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