Thyroid Dysfunction, Hypertriglyceridemia, and Hypertension as a Cardiometabolic Axis: Systematic Review of Pathophysiological Mechanisms and Clinical Evidence (2021–2026)
DOI:
https://doi.org/10.70577/asce.v5i4.1129Keywords:
Thyroid dysfunction, Cardiometabolic axis, Arterial hypertension, Hypertriglyceridemia, Insulin resistanceAbstract
Thyroid dysfunction presents a challenge that extends beyond the endocrine realm due to its close association with metabolic and cardiovascular abnormalities; notably, changes in thyroid function—even within ranges considered normal—can be linked to alterations in lipid metabolism, insulin resistance, arterial hypertension, and cardiovascular risk. The objective was to critically analyze scientific evidence published between 2021 and 2026 regarding the relationship between thyroid dysfunction, hypertriglyceridemia, and arterial hypertension, with an emphasis on the pathophysiological mechanisms that might integrate these abnormalities within a cardiometabolic axis. A systematic review was conducted following PRISMA 2020 guidelines; the search was performed in Scopus, PubMed/MEDLINE, and Web of Science using terms related to thyroid function, triglycerides, insulin resistance, the TyG index, and arterial hypertension. The evidence identified consistent relationships between alterations in thyroid function and changes in triglyceride metabolism, as well as associations between the TyG index, insulin resistance, and arterial hypertension. The results indicated that BMI, visceral adiposity, age, sex, and diabetes act as significant modifiers of these associations. The evidence supports the existence of a cardiometabolic axis linking thyroid function, lipid metabolism, and vascular regulation; however, it is not yet possible to establish a definitive causal relationship among these alterations. Insulin resistance and the TyG index emerge as potential connecting elements, while methodological heterogeneity and a scarcity of longitudinal studies limit the causal interpretation of the findings.
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References
Ahmadi, N., Ahmadi, F., Sadiqi, M., Ziemnicka, K., & Minczykowski, A. (2020). Thyroid gland dysfunction and its effect on the cardiovascular system: A comprehensive review of the literature. Endokrynologia Polska, 71(5), 466-478. https://doi.org/10.5603/EP.a2020.0052 DOI: https://doi.org/10.5603/EP.a2020.0052
Ballena-Caicedo, J., Zuzunaga-Montoya, F. E., Loayza-Castro, J. A., Bustamante-Rodríguez, J. C., Vásquez Romero, L. E. M., Tapia-Limonchi, R., De Carrillo, C. I. G., & Vera-Ponce, V. J. (2025). Global prevalence of insulin resistance in the adult population: A systematic review and meta-analysis. Frontiers in Endocrinology, 16, 1646258. https://doi.org/10.3389/fendo.2025.1646258 DOI: https://doi.org/10.3389/fendo.2025.1646258
Baretella, O., Blum, M. R., Abolhassani, N., Alwan, H., Wildisen, L., Del Giovane, C., Tal, K., Moutzouri, E., Åsvold, B. O., Cappola, A. R., Gussekloo, J., Iacoviello, M., Iervasi, G., Imaizumi, M., Weiler, S., Razvi, S., Sgarbi, J. A., Völzke, H., Brown, S. J., … Rodondi, N. (2025). Associations Between Subclinical Thyroid Dysfunction and Cardiovascular Risk Factors According to Age and Sex. The Journal of Clinical Endocrinology & Metabolism, 110(5), e1315-e1322. https://doi.org/10.1210/clinem/dgae860 DOI: https://doi.org/10.1210/clinem/dgae860
Chen, J., Wu, K., Lin, Y., Huang, M., & Xie, S. (2023). Association of triglyceride glucose index with all-cause and cardiovascular mortality in the general population. Cardiovascular Diabetology, 22(1), 320. https://doi.org/10.1186/s12933-023-02054-5 DOI: https://doi.org/10.1186/s12933-023-02054-5
Cicatiello, A. G., Miro, C., Sagliocchi, S., Nappi, A., & Dentice, M. (2026). Thyroid hormones and metabolic flexibility: Tissue-specific control of energy homeostasis. Frontiers in Physiology, 17, 1882438. https://doi.org/10.3389/fphys.2026.1882438 DOI: https://doi.org/10.3389/fphys.2026.1882438
Curcio, M., & Vincent, R. P. (2026). The Thyroid–Metabolism Axis: Pathways of Dysregulation and the Effects of Treatment. Metabolites, 16(4), 267. https://doi.org/10.3390/metabo16040267 DOI: https://doi.org/10.3390/metabo16040267
Debmalya, S., Saumitra, R., & Singh, M. H. (2022). Interplay between cardiovascular and thyroid dysfunctions: A review of clinical implications and management strategies. Endocrine Regulations, 56(4), 311-328. https://doi.org/10.2478/enr-2022-0033 DOI: https://doi.org/10.2478/enr-2022-0033
Dharia, A., Desai, D., & Desai, K. (2025). Exploring the Link Between Thyroid Disorders and Obesity: Mechanisms, Impacts, and Clinical Implications. Endocrine Practice, 31(5), 660-667. https://doi.org/10.1016/j.eprac.2025.02.005 DOI: https://doi.org/10.1016/j.eprac.2025.02.005
Dobre, M.-Z., Virgolici, B., & Cioarcă-Nedelcu, R. (2025). Lipid Hormones at the Intersection of Metabolic Imbalances and Endocrine Disorders. Current Issues in Molecular Biology, 47(7), 565. https://doi.org/10.3390/cimb47070565 DOI: https://doi.org/10.3390/cimb47070565
Gallo, G., & Savoia, C. (2024). New Insights into Endothelial Dysfunction in Cardiometabolic Diseases: Potential Mechanisms and Clinical Implications. International Journal of Molecular Sciences, 25(5), 2973. https://doi.org/10.3390/ijms25052973 DOI: https://doi.org/10.3390/ijms25052973
Gong, Y., Wang, G., Zhang, Q., Jiang, X., Zhu, Z., & Li, Y. (2025). Impaired central sensitivity to thyroid hormone is associated with hypertriglyceridemia in euthyroid population. Frontiers in Endocrinology, 16, 1616907. https://doi.org/10.3389/fendo.2025.1616907 DOI: https://doi.org/10.3389/fendo.2025.1616907
Hamooya, B. M., Siame, L., Muchaili, L., Masenga, S. K., & Kirabo, A. (2025). Metabolic syndrome: Epidemiology, mechanisms, and current therapeutic approaches. Frontiers in Nutrition, 12, 1661603. https://doi.org/10.3389/fnut.2025.1661603 DOI: https://doi.org/10.3389/fnut.2025.1661603
Hatziagelaki, E., Paschou, S. A., Schön, M., Psaltopoulou, T., & Roden, M. (2022). NAFLD and thyroid function: Pathophysiological and therapeutic considerations. Trends in Endocrinology & Metabolism, 33(11), 755-768. https://doi.org/10.1016/j.tem.2022.08.001 DOI: https://doi.org/10.1016/j.tem.2022.08.001
He, J., Lai, Y., Yang, J., Yao, Y., Li, Y., Teng, W., & Shan, Z. (2021). The Relationship Between Thyroid Function and Metabolic Syndrome and Its Components: A Cross-Sectional Study in a Chinese Population. Frontiers in Endocrinology, 12, 661160. https://doi.org/10.3389/fendo.2021.661160 DOI: https://doi.org/10.3389/fendo.2021.661160
Iglesias, P., & Iglesias, I. (2025). Hormonal crossroads of the heart: From classic endocrine regulation to cardiac hormone secretion: an updated review. Journal of Endocrinological Investigation, 49(4), 747-761. https://doi.org/10.1007/s40618-025-02767-2 DOI: https://doi.org/10.1007/s40618-025-02767-2
Kalra, S., Aggarwal, S., & Khandelwal, D. (2021). Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies. International Journal of Endocrinology, 2021, 1-11. https://doi.org/10.1155/2021/9641846 DOI: https://doi.org/10.1155/2021/9641846
Li, L., Cai, G., Lu, W., Li, F., Yu, L., & Xiao, J. (2023). Interaction between triglyceride-glucose index and thyroid hormones on coronary artery disease risk in patient with euthyroid. Frontiers in Endocrinology, 14, 1255656. https://doi.org/10.3389/fendo.2023.1255656 DOI: https://doi.org/10.3389/fendo.2023.1255656
Lin, Y., Sun, R., Wu, L., Chen, L., Fu, C., Yan, S., & Cai, J. (2026). Association between the triglyceride–glucose index and hypertension: Potential role of fatty liver in a cross-sectional study. Frontiers in Endocrinology, 17, 1826006. https://doi.org/10.3389/fendo.2026.1826006 DOI: https://doi.org/10.3389/fendo.2026.1826006
Müller, P., Leow, M. K.-S., & Dietrich, J. W. (2022). Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence. Frontiers in Cardiovascular Medicine, 9, 942971. https://doi.org/10.3389/fcvm.2022.942971 DOI: https://doi.org/10.3389/fcvm.2022.942971
Nayak, S. S., Kuriyakose, D., Polisetty, L. D., Patil, A. A., Ameen, D., Bonu, R., Shetty, S. P., Biswas, P., Ulrich, M. T., Letafatkar, N., Habibi, A., Keivanlou, M.-H., Nobakht, S., Alotaibi, A., Hassanipour, S., & Amini-Salehi, E. (2024). Diagnostic and prognostic value of triglyceride glucose index: A comprehensive evaluation of meta-analysis. Cardiovascular Diabetology, 23(1), 310. https://doi.org/10.1186/s12933-024-02392-y DOI: https://doi.org/10.1186/s12933-024-02392-y
Neves, J. S., Fontes-Carvalho, R., Borges-Canha, M., Leite, A. R., Von Hafe, M., Vale, C., Martins, S., Guimarães, J. T., Carvalho, D., Leite-Moreira, A., & Azevedo, A. (2022). Association of thyroid function, within the euthyroid range, with cardiovascular risk: The EPIPorto study. Frontiers in Endocrinology, 13, 1067801. https://doi.org/10.3389/fendo.2022.1067801 DOI: https://doi.org/10.3389/fendo.2022.1067801
Omidi, N., Khorgami, M., Tajrishi, F. Z., Seyedhoseinpour, A., & Pasbakhsh, P. (2020). The Role of Thyroid Diseases and their Medications in Cardiovascular Disorders: A Review of the Literature. Current Cardiology Reviews, 16(2), 103-116. https://doi.org/10.2174/1573403X15666191008111238 DOI: https://doi.org/10.2174/1573403X15666191008111238
Parveen, G., Ansari, W. A., Kumar, N., & Jaiswal, D. K. (2026). Harnessing secondary metabolites of endophytic microbes: A next-generation biopesticide for crop disease management. Frontiers in Microbiology, 16, 1705702. https://doi.org/10.3389/fmicb.2025.1705702 DOI: https://doi.org/10.3389/fmicb.2025.1705702
Paschou, S. A., Bletsa, E., Stampouloglou, P. K., Tsigkou, V., Valatsou, A., Stefanaki, K., Kazakou, P., Spartalis, M., Spartalis, E., Oikonomou, E., & Siasos, G. (2022). Thyroid disorders and cardiovascular manifestations: An update. Endocrine, 75(3), 672-683. https://doi.org/10.1007/s12020-022-02982-4 DOI: https://doi.org/10.1007/s12020-022-02982-4
Patrizio, A., Ferrari, S. M., Elia, G., Ragusa, F., Balestri, E., Botrini, C., Rugani, L., Mazzi, V., Antonelli, A., Fallahi, P., & Benvenga, S. (2024). Hypothyroidism and metabolic cardiovascular disease. Frontiers in Endocrinology, 15, 1408684. https://doi.org/10.3389/fendo.2024.1408684 DOI: https://doi.org/10.3389/fendo.2024.1408684
Pingitore, A., Gaggini, M., Mastorci, F., Sabatino, L., Cordiviola, L., & Vassalle, C. (2024). Metabolic Syndrome, Thyroid Dysfunction, and Cardiovascular Risk: The Triptych of Evil. International Journal of Molecular Sciences, 25(19), 10628. https://doi.org/10.3390/ijms251910628 DOI: https://doi.org/10.3390/ijms251910628
Wang, D., Li, W., Zhou, M., Ma, J., Guo, Y., Yuan, J., He, M., Zhang, X., & Chen, W. (2024). Association of the triglyceride-glucose index variability with blood pressure and hypertension: A cohort study. QJM: An International Journal of Medicine, 117(4), 277-282. https://doi.org/10.1093/qjmed/hcad252 DOI: https://doi.org/10.1093/qjmed/hcad252
Wang, X., Zhang, Q., Liu, H., Hu, Y., Wang, Y., Wang, Y., Yang, K., & Li, Y. (2026). Thyroid hormone sensitivity, insulin resistance and visceral fat area as determinants of prevalent coronary heart disease in euthyroid patients with type 2 diabetes. Frontiers in Endocrinology, 17, 1757587. https://doi.org/10.3389/fendo.2026.1757587 DOI: https://doi.org/10.3389/fendo.2026.1757587
Xin, F., He, S., Zhou, Y., Jia, X., Zhao, Y., & Zhao, H. (2023). The triglyceride glucose index trajectory is associated with hypertension: A retrospective longitudinal cohort study. Cardiovascular Diabetology, 22(1), 347. https://doi.org/10.1186/s12933-023-02087-w DOI: https://doi.org/10.1186/s12933-023-02087-w
Xu, W., Zhao, H., Gao, L., Guo, L., Liu, J., Li, H., Sun, J., Xing, A., Chen, S., Wu, S., & Wu, Y. (2023). Association of long-term triglyceride-glucose index level and change with the risk of cardiometabolic diseases. Frontiers in Endocrinology, 14, 1148203. https://doi.org/10.3389/fendo.2023.1148203 DOI: https://doi.org/10.3389/fendo.2023.1148203
Yang, C., Song, Y., & Wang, P. (2024). Relationship between triglyceride-glucose index and new-onset hypertension in general population–a systemic review and meta-analysis of cohort studies. Clinical and Experimental Hypertension, 46(1), 2341631. https://doi.org/10.1080/10641963.2024.2341631 DOI: https://doi.org/10.1080/10641963.2024.2341631
Yu, O. H. Y., Filliter, C., Filion, K. B., Platt, R. W., Grad, R., & Renoux, C. (2024). Levothyroxine Treatment of Subclinical Hypothyroidism and the Risk of Adverse Cardiovascular Events. Thyroid®, 34(10), 1214-1224. https://doi.org/10.1089/thy.2024.0227 DOI: https://doi.org/10.1089/thy.2024.0227
Zhang, C., Wang, H., Li, Y., Wang, X., Han, Y., Gao, X., Lai, Y., Wang, C., Teng, W., & Shan, Z. (2024). Association between the triglyceride-glucose index and thyroid disorders: A cross-sectional survey and Mendelian randomization analysis. Endocrine, 86(1), 173-185. https://doi.org/10.1007/s12020-024-03858-5 DOI: https://doi.org/10.1007/s12020-024-03858-5
Zhang, D., Wei, Y., Huang, Q., Chen, Y., Zeng, K., Yang, W., Chen, J., & Chen, J. (2022). Important Hormones Regulating Lipid Metabolism. Molecules, 27(20), 7052. https://doi.org/10.3390/molecules27207052 DOI: https://doi.org/10.3390/molecules27207052
Zhao, F., Yang, Y., & Yang, W. (2025). Exploring the causal impact of body mass index on metabolic biomarkers and cholelithiasis risk: A Mendelian randomization analysis. Scientific Reports, 15(1), 415. https://doi.org/10.1038/s41598-024-83217-6 DOI: https://doi.org/10.1038/s41598-024-83217-6
Zhou, X., Zhang, Y., & Li, Z. (2025). Impaired sensitivity to thyroid hormones is positively associated to metabolic syndrome severity in euthyroid Chinese adults as revealed by a cross-sectional study. Frontiers in Endocrinology, 16, 1552484. https://doi.org/10.3389/fendo.2025.1552484 DOI: https://doi.org/10.3389/fendo.2025.1552484
Zou, X., Zhou, C., Zhou, R., Zhu, T., Zhao, J., Qing, W., Xie, J., Yu, R., Zhang, F., & Li, J. (2026). The joint association of the combined triglyceride-glucose index and atherogenic index of plasma with hypertension on stroke risk across different glycemic status: A prospective cohort study. Cardiovascular Diabetology, 25(1), 141. https://doi.org/10.1186/s12933-026-03080-9 DOI: https://doi.org/10.1186/s12933-026-03080-9
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Copyright (c) 2026 Fabio Camilo Jaramillo Contreras, Rocío Noemí Guamán Guamán, Silvia Paulina Inga Huilca, Jesús Javier Ñaccha Urbano, Miguel Santiago Sandoval Romo

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