Overt hypothyroidism was associated with early atherosclerotic changes and dyslipidaemia, and Anti-TPO antibodies correlated with CIMT and were associated with elevated total cholesterol in an adjusted model, but findings are hypothesis-generating and require prospective external validation before clinical implementation.
Key Findings
Results
Overt hypothyroidism was associated with higher carotid intima-media thickness (CIMT) and a greater burden of abnormal CIMT categories compared to other thyroid-status groups.
The study enrolled 82 consecutive adult patients with thyroid dysfunction from a tertiary care centre in eastern India.
Thyroid dysfunction groups included overt hypothyroidism, subclinical hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism.
Peak systolic velocity was also highest in the overt hypothyroidism group.
Patients receiving thyroid hormone supplementation, antithyroid medication, or lipid-lowering treatment were excluded to avoid confounding.
Results
TSH was positively correlated with CIMT in the overall cohort.
Spearman rho = 0.65; p < 0.001 for the correlation between TSH and CIMT.
This correlation was observed across the full cohort of 82 patients with thyroid dysfunction.
The analysis used Spearman rank correlation, appropriate for non-normally distributed data.
Total cholesterol was highest in the overt hypothyroid group among all thyroid-status groups.
Results
Anti-TPO antibodies were positively correlated with CIMT in the overall cohort.
Spearman rho = 0.60; p < 0.001 for the correlation between Anti-TPO and CIMT.
This suggests thyroid autoimmunity, independent of hormone levels, may be associated with early atherosclerotic changes.
The cross-sectional design precludes causal inference from this association.
Results
In exploratory multivariable logistic regression, log10(Anti-TPO) was associated with hypercholesterolaemia, whereas log10(TSH) was not independently associated after adjustment.
log10(Anti-TPO): OR 13.629, 95% CI: 1.174–190.489; p = 0.0421.
log10(TSH): OR 1.243, p = 0.6904, indicating no independent association after adjustment.
The wide confidence interval for the Anti-TPO odds ratio (1.174–190.489) indicates substantial imprecision.
The outcome was elevated total cholesterol defined as >200 mg/dL.
The authors explicitly state this finding requires external validation.
Results
The internally assessed multivariable logistic regression model showed acceptable discrimination for predicting hypercholesterolaemia.
AUC = 0.834, 95% CI: 0.748–0.920.
The authors describe this as 'acceptable discrimination' based on internal model performance only.
The authors caution that internal AUC assessment is subject to optimism and that external validation is needed.
The model was described as exploratory given the sample size of 82 patients.
Methods
The study was a single-centre cross-sectional observational study with a 12-month feasibility recruitment period and a post-hoc power assessment.
82 consecutive eligible adult patients were recruited over a prespecified 12-month feasibility period from a tertiary care centre in eastern India.
Sample size was based on available recruitment and supported by a post-hoc power/precision assessment for the principal correlation analyses.
Thyroid and lipid measurements were performed using routine automated clinical laboratory methods.
Carotid ultrasound was used to assess CIMT.
Multivariable binary logistic regression was used to identify exploratory predictors of elevated total cholesterol.
Conclusions
The authors conclude that findings regarding Anti-TPO and atherosclerotic markers should be considered hypothesis-generating only.
The cross-sectional design precludes causal inference.
The wide confidence interval for the Anti-TPO odds ratio indicates substantial imprecision.
The authors explicitly state findings 'require prospective external validation before clinical implementation.'
The study is described as a single-centre exploratory cohort.
What This Means
This research suggests that among people with thyroid disorders, those with overt (fully developed) hypothyroidism—an underactive thyroid—show more signs of early artery disease, including thicker carotid artery walls (a marker called CIMT) and higher cholesterol levels, compared to people with other types of thyroid dysfunction. The study also found that higher TSH levels (a hormone that rises when the thyroid is underactive) were strongly linked to thicker carotid artery walls across all patients. Notably, higher levels of Anti-TPO antibodies—proteins produced when the immune system attacks the thyroid—were also associated with thicker artery walls and elevated cholesterol, even after accounting for other factors.
One particularly striking statistical finding was that Anti-TPO antibody levels appeared to be a stronger predictor of high cholesterol than TSH levels in the multivariable analysis. However, the authors are careful to note that this result is highly uncertain—the confidence interval around the estimated effect was very wide—and the study's small size (82 patients at one hospital in India) and cross-sectional design mean it cannot establish cause and effect. The study also excluded patients already on thyroid medications or cholesterol-lowering drugs, which is important for understanding the untreated relationships between these conditions.
This research suggests that thyroid autoimmunity (the immune attack on the thyroid, measured by Anti-TPO antibodies) may contribute to cardiovascular risk beyond just the hormone imbalance itself, but these are preliminary, hypothesis-generating findings. Larger, prospective studies following patients over time and conducted at multiple centres would be needed to confirm these associations before they could have any implications for how thyroid patients are monitored or treated for cardiovascular risk.
Roy P, Naskar A, Rahman M, Mandal S, Dhali A, Mukherjee A, et al.. (2026). Predictors of atherosclerosis and dyslipidaemia among patients with thyroid disease: a cross-sectional analysis.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1814468