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Mild symptoms of hypothyroidism, including psychiatric and cognitive abnormalities, are found in approximately 30% of patients with SH, but the average TSH level usually exceeds 11 microunits/mL. Cardiac dysfunction, including impaired left ventricular diastolic function at rest, systolic dysfunction with exercise, atherosclerosis, CHF, and MI has been reported. 85,88,153–155 Data showing an increased risk of coronary heart disease (CHD) are conflicting and influenced by the severity of SH, study design, and length of follow-up. A meta-analysis noted a 1.6 times increased risk of CHD, 156 a cross-sectional analysis noted an odds ratio of 2.2 only in those with TSH levels of ≥10 microunits/mL, whereas a 20-year longitudinal analysis found a significant risk (hazard ratio (HR) of 1.7) regardless of the degree of TSH elevation. 157 However, a large prospective cohort study found no significant association with atherosclerotic disease or cardiac mortality but observed an increase in all-ca

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