Physiological Effect of Hypothyroidism on Blood Pressure in Women

Physiological Effect of Hypothyroidism on Blood Pressure in Women Dalal F. Al-Akabi  College of Health and Medical Techniques, Southern Technical University, Basrah, Iraq Abstract Background: Hypothyroidism is a chronic disease that occurs when thyroid gland doesn't produce enough thyroid hormones and without treatment HT may lead to serious health problems such as cardiovascular and metabolic diseases. Objective: The study aims to measure the level of some serum parameters that may associated with the occurrence of hypertension in HT women. Methodology: 90 serum samples, divide equally as patient and control were collected in a private laboratory based on the diagnosis of an internist, ELISA technique was used to record the levels of samples serum TSH, renin, aldosterone, cortisol, vasopressin, while TG, Total chole, LDL-C, HDL-C were measured by spectrophotometer for both patients and healthy samples. SPSS version 26 was used in the statistical analysis of results (p≤0.05). Results: Increase in the serum TSH, renin, vasopressin, TG, Total chole, LDL-C, HDL-C in HT patients compared with control group, a significant increase in the level of systolic presser and diastolic presser in patients. TSH level showed a significant variation between patients under the effect of BMI and history of the disease and significant correlation was recorded between blood presser with TSH, renin and vasopressin. Conclusion: The women with HT showed an abnormality in the level of some hormones that are associated with hypertension. Introduction Hypothyroidism (HT) one of the common diseases that cause infertility, hypertension, cognitive impairment dyslipidemia and neuromuscular abnormalities, the prevalence of the disease increases with age, also in females more than males, and HT may occur due to the failure of hypothalamus to stimulate the thyroid gland and the common causes of the disease is thyroid autoimmune diseases [1]. HT spreads, especially among women and older ages, where the patient suffers from dry skin, fatigue, obesity, intolerance to cold, voice change and catch also in severe cases myxedema, where the diagnosis of HT is done by measurement of blood TSH and T4 levels and treatment with levothyroxine is adopted to restore the normal level and reduce symptoms [2]. Because it is possible to confuse HT symptoms with other diseases, so laboratory examination is necessary and it was noted that elderly and women patients are delayed in diagnosing because of that, where HT prevalence depends on several factors, including age, sex and iodine availability [3]. High level of TSH and hypertension in HT patients may increase the possibility of developing the coronary artery disease [4]. Hypertension in HT patients is associated with DIO2 polymorphism, where genetic difference of hypothalamic-pituitary-thyroid pathway increases the chance of developing hypertension in HT patients [5]. High blood pressure is common among subclinical hypothyroidism women younger than 65 years compared with euthyroid women and the occurrence of hypertension increases with the increase of TSH level in these patients [6]. An imbalance in the level of thyroid hormones may lead to alterations in blood pressure level and late diagnosis of a subclinical hypothyroidism and hyperthyroidism may lead to a risk of cardiovascular manifestations [7]. Subclinical hypothyroidism patients suffer from the 1 and 2 stages of hyperthyroidism with high hsCRP level and dyslipidemia as a risk factor for cardiac abnormalities [8]. High TSH level even within normal value in primary hypothyroidism patients has a strong effect on the patient's quality of life and health condition, and levothyroxine treatment may be not effective, especially in mild hypothyroidism [9,10]. Thyroid hormones stimulate nuclear receptors to transcript More Information How to cite this article: Al-Akabi DF. Physiological Effect of Hypothyroidism on Blood Pressure in Women. Eur J Med Health Res, 2025;3(5):188-93. DOI: 10.59324/ejmhr.2025.3(5).26 Keywords: Hypothyroidism, hypertension, renin, vasopressin This work is licensed under a Creative Commons Attribution 4.0 International License. The license permits unrestricted use, distribution, and reproduction in any medium, on the condition that users give exact credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if they made any changes. EUR J MED HEALTH RES Volume 3 | Number 5 | 2025 189 many heart proteins, which affects its functions, as overt hypothyroidism increases vascular resistance, reduces heart contraction and increase diastolic pressure of blood, where renal dysfunction may contribute to hypertension in HT patients [11]. Renin is produced by the kidney and has an important role in homeostasis of salt levels and blood pressure and its production is stimulated by the parathyroid hormone [12]. Aldosterone is a steroid hormone that has a role in regulating of the conservation of sodium, where its acts through mineralocorticoid receptor to stimulate the transport of potassium and sodium to the target tissue and the defective hormone evident in hypertension due to its pathophysiologic actions [13,14]. Vasopressin is a neurohormone peptide that is synthesis in many cells and stored in vesicles within, plays a role as antidiuretic and in the regulation of blood flow also has a role in parental behavior and responding to stress [15]. Methodology Collection of Samples The present study was accomplished in Basra/ Iraq, (March - July 2023), serum was collected (45 HT women and 45 healthy women) from a private laboratory under supervision of an internist. According to the special questionnaire, HT patients were grouped according to (BMI, Age, history of disease). Exclusion Criteria It was established that all samples fit to non-pregnant women, have diabetes mellitus or from hormonal, blood, inflammatory and autoimmune diseases, or other disease that may disturb the parameters in the current study. Also women who have been taking medications for at least four months were excluded. Measuring Hormone Levels and Other Biomarkers Serum hormones levels were measured using ELISA kits; TSH, renin, aldosterone, cortisol, vasopressin (SunLong Biotech/China). TG, Total chole, LDL-C, HDL-C (Biolabo/France) by spectrophotometer. Statistical analysis was accomplished by (SPSS version 26/ p<0.05 / One way Anova, T-Test, Pearson's correlation). Results The percentages of sample distribution for patients and control are shown in Table 1. Table 1: Demographic Data of the Study Sample Control (N=45) Patients (N=45) Group Category 26.7% 23.3% 45-55 Age(year) 22.2% 27.8% 56-65 27.8% 21.1% Normal BMI 17.8% 20.0% Pre-obesity 4.4% 8.9% Obese class1 46.7% <5 History of the disease 53.3% >5 The results displayed a significant increase in the serum TSH, renin, vasopressin, TG, Total chole, LDL-C, HDL-C, a non-significant variation was observed in cortisol and aldosterone in HT patients compared with control (Table 2). Table 2: Comparison of Study Parameters among Patients and Control Groups, Values were Expressed as Mean ± Standard Deviation Serum parameters Patients (N=45) Mean±SD Control (N=45) Mean±SD TSH 1781.48±488.64 631.76±185.42* Renin 62.20±22.81 163.64±65.21* Aldosterone 2.52±1.38 2.16±1.30 Cortisol 78.51±14.50 48.27±15.83 Vasopressin 70.25±25.26 38.73±13.02* TG 162.26±49.83 69.84±35.21* Total chole 211.94±40.17 105.93±51.83* LDL-C 137.78±28.89 92.72±39.57* HDL-C 51.95±13.36 50.80±15.34 *Significant at p≤0.05, independentsamples T test EUR J MED HEALTH RES Volume 3 | Number 5 | 2025 190 As shown in (Table 3) there is a significant increase in the level of systolic presser and diastolic presser in patients, compared with control. Table 3: Comparison of Blood Presser among Patients and Control Groups, Values were Expressed as Mean ± Standard Deviation Serum parameters Patients (N=45) Mean±SD Control (N=45) Mean±SD Systolic presser 139.24±14.370 126.16±6.350* Diastolic presser 90.24±7.358 83.24±3.607* *Significant at p≤0.05, independentsamples T test The present study recorded a non-significant variation in the concentration of the significant serum parameters between patients according to the age factor, while there is no significant variance was observed in the other parameters (Table 4). Table 4: Comparison of the Significant Parameters in Patients According to Age Factor, Values was Expressed as (mean ± standard deviation) Age (56-65) year (n=24) Age (45-55) year (n=21) Serum hormones / Age 1809.73±473.27 1749.18±515.42 TSH 59.15±24.67 65.67±20.53 Renin 67.81±28.36 73.03±21.55 Vasopressin *Significant at the (p≤0.05) The study results also showed a significant increase in TSH between patients according to the BMI factor, while there is no significant variance was observed in the other parameters (Table 5). Table 5: Comparison of the Significant Hormones in Patients According to BMI Factor, Values was Expressed as (mean ± standard deviation) Obese (n=8) Overweight (n=18) Normal (n=19) Serum hormones / BMI 1971.98±505.88* 1768.06±382.05 1384.70±479.83 TSH 65.35±23.43 62.26±22.98 60.81±23.53 Renin 75.30±19.42 72.22±29.02 66.25±24.21 Vasopressin *Significant at the (p≤0.05) As shown in (Table 6) a significant increase was observed in the level of serum TSH between patients according to history of the disease factor, while there is no significant variance was observed in the other parameters. Table 6: Comparison of the Significant Hormones in Patients According to History of the Disease Factor, Values was Expressed as (mean ± standard deviation) >5years (n=24) <5years (n=21) Serum hormones/ history of the disease/years 1685.81±481.65* 1865.18±489.26 TSH 68.70±22.26 56.51±22.20 Renin 71.22±26.02 69.40±25.11 Vasopressin *Significant at the (p≤0.05) The present study showed systolic presser and diastolic presser exhibited a positive correlation with TSH and with Vasopressin, while a negative correlation with renin was recorded (Table 7). EUR J MED HEALTH RES Volume 3 | Number 5 | 2025 191 Table 7: The Correlation of Blood Presser with the Significant Hormones Vasopressin Renin TSH Variables 0.341** -0.274** 0.384** Systolic presser 0.411** -0.394** 0.484** Diastolic presser **Correlation is significant at the 0.01 level. *Correlation is significant at the 0.05 level. Discussion It was observed in a laboratory study that renin and Angiotensin I decreases in mice with hypothyroidism with a clear decrease in blood pressure in these mice [16]. Renin‑angiotensin system plays an important role in diabetes, blood pressure and kidney disease by angiotensin II-mediated reaction of angiotensin II type 1 receptor via its signaling pathways and mechanisms [17]. Thyroid hormones play an important role in the functions of the circulatory system, where cardiovascular dysfunction has been observed in thyroid patients, as studies have shown that renin mediates this function of thyroid hormones [18]. It was observed that HT patients had a lower level of electrolytes; chloride, sodium and potassium in serum compared to healthy people, while no difference in the level of cortisol and aldosterone [19,20]. Low thyroid hormones may cause a lack of sodium level in patients with hypothyroidism [21]. Another study showed no significant difference in electrolyte levels in subclinical hypothyroidism when compare with subclinical hyperthyroidism [22]. HT may cause hyponatremia and one of the mechanics that explains this is the defect in the water and sodium excretion in the kidney [23]. It has been observed that the cortisol increases with the high level of TSH in subclinical hypothyroid young people [24]. Another study recorded a high level of cortisol and a decreased level of vitamin D3 in overt hypothyroidism patients [25]. HT women of reproductive age show different degrees of stress response depending on the severity of the disease, where it was observed a clear association between HT, depression and hypercortisolemia [26]. Alamara et al., recorded an increased level of vasopressin in HT patients and this rise may occur due to a decreased thyroid hormones level in these patients, as this study showed an association between the HT and blood biomarkers related to neurological anomalies [27]. It was noted that acute hypothyroidism may cause high potassium level, low sodium and renin, but no change was shown in the level of aldosterone, vasopressin, cortisol [28]. It was recorded that the increased level of TSH in HT patents is associated with high level of lipids, especially LDL-C, and this may lead to the development of cardiovascular and metabolic disease in HT patients, where the treatment with thyroid hormones is effective in reversing this rise in lipids [29]. HT is associated with high TG, chole, LDL-C and involves in the production of dysfunctional HDL-C, because thyroid hormones regulate the production of cholesterol and high TSH level in HT patients associated with hyperlipidemia [30]. HDL is considered as an indicator of cardiovascular disease and has a unstable level and dysfunction properties in HT disease, due to some regulatory factors that interact with each other, like SREBPs, ANGPTLs ,FGF19/21 and ChREBP, that involved in the lipid metabolism [31]. A study recorded a significant increase in TG, cholesterol and LDL-C in subclinical hypothyroidism patients compared to healthy people, but no significant difference in blood pressure was observed in these patients [32]. High blood pressure, lipids, BMI and Abnormal ECG were recorded in primary hypothyroidism compared to control, indicating obvious cardiovascular appearances [33]. Despite the effect of thyroid hormones on blood pressure, no significant correlation was recorded between systolic and diastolic BP blood pressure with TSH in HT patients [34]. Hypertension was observed in subclinical hypothyroidism cases, especially women in middle age compared to older women, where the first category must be treated regardless of TSH level [35]. Conclusion The women with HT showed an abnormality in the level of some hormones that are associated with hypertension. Ethical Approval Ethical approval was obtained for the study from the Research Ethics Committee of the College of Health and Medical Techniques, Southern Technical University, Basrah, Iraq. Verbal informed consent was obtained from all participating patients. Conflict of Interest The author declares no conflict of interest in this study. Funding No funding. References [1] Gaitonde D, Rowley K, Sweeney L. Hypothyroidism: an update. S Afr Fam Pract. 2012;54(5):384-390. doi: 10.1080/20786204.2012.10874256 [2] Wilson SA, Stem LA, Bruehlman RD. Hypothyroidism: Diagnosis and treatment. Am Fam Physician. 2021;103(10):605-613. [3] Gottwald-Hostalek U, Schulte B. 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