{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:48:31Z","timestamp":1785840511862,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Congenital hypothyroidism (CH) is a common endocrine disorder characterized by thyroid hormone deficiency and has dramatic consequences if diagnosis and treatment are delayed. Although neonatal screening (NNS) and early levothyroxine (L-T4) treatment have markedly improved neurodevelopmental outcomes, evidence suggests that cardiovascular alterations may persist into later life. Thyroid hormones regulate lipid metabolism, endothelial nitric oxide (NO) availability, myocardial relaxation, vascular tone and arterial wall homeostasis. Early clinical studies in patients with CH reported variable lipid and lipoprotein abnormalities, whereas more recent studies have demonstrated endothelial dysfunction, increased arterial stiffness, and elevated carotid intima\u2013media thickness (IMT), even in the absence of classical cardiovascular risk factors. These alterations appear to be associated with cumulative exposure to thyroid-stimulating hormone (TSH) abnormalities rather than isolated biochemical measurements. These findings suggest that CH may affect cardiovascular biology through multiple pathways, including dyslipidemia, endothelial dysfunction, vascular remodeling, and cumulative exposure to thyroid-stimulating hormone abnormalities. This review summarizes the available evidence linking congenital hypothyroidism to early vascular and atherosclerotic changes and discusses its conceptual relationship to familial hypercholesterolemia as another model of early-life cumulative cardiovascular risk.<\/jats:p>","DOI":"10.3390\/jcdd13080369","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T09:15:22Z","timestamp":1785834922000},"page":"369","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Congenital Hypothyroidism and Atherosclerosis: An Endocrine Model of Early-Life Cardiovascular Risk"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0975-1355","authenticated-orcid":false,"given":"Maria","family":"Tzoraki","sequence":"first","affiliation":[{"name":"Department of Endocrinology, Growth and Development, Children\u2019s Hospital P. & A. Kyriakou, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9133-4089","authenticated-orcid":false,"given":"Leonidas H.","family":"Duntas","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology, Diabetes and Metabolism, Evgenideion Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1089\/thy.2020.0333","article-title":"Congenital hypothyroidism: A 2020\u20132021 consensus guidelines update\u2014An ENDO-European Reference Network initiative endorsed by the European Society for Pediatric Endocrinology and the European Society for Endocrinology","volume":"31","author":"Stoupa","year":"2021","journal-title":"Thyroid"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e250125","DOI":"10.1530\/ETJ-25-0125","article-title":"50 years of newborn screening for congenital hypothyroidism: Evolution of insights in etiology, diagnosis and management: Management during pregnancy and long-term outcomes of adult patients with congenital hypothyroidism","volume":"14","author":"Luton","year":"2025","journal-title":"Eur. Thyroid J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e230041","DOI":"10.1530\/ETJ-23-0041","article-title":"Neonatal screening for primary and central congenital hypothyroidism: Is it time to go Dutch?","volume":"12","author":"Boelen","year":"2023","journal-title":"Eur. Thyroid J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1725","DOI":"10.1161\/CIRCULATIONAHA.106.678326","article-title":"Thyroid disease and the heart","volume":"116","author":"Klein","year":"2007","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.mcna.2012.01.012","article-title":"The effect of thyroid disorders on lipid levels and metabolism","volume":"96","author":"Duntas","year":"2012","journal-title":"Med. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1001\/jama.2010.1361","article-title":"Subclinical hypothyroidism and the risk of coronary heart disease and mortality","volume":"304","author":"Rodondi","year":"2010","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3478","DOI":"10.1093\/eurheartj\/eht273","article-title":"Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: Guidance for clinicians to prevent coronary heart disease: Consensus statement of the European Atherosclerosis Society","volume":"34","author":"Nordestgaard","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.1093\/eurheartj\/ehv157","article-title":"Familial hypercholesterolaemia in children and adolescents: Gaining decades of life by optimizing detection and treatment","volume":"36","author":"Wiegman","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s12020-023-03420-9","article-title":"Hypothyroidism, lipids, and lipidomics","volume":"84","author":"Jonklaas","year":"2024","journal-title":"Endocrine"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"34114","DOI":"10.1074\/jbc.M305417200","article-title":"Thyroid hormone regulation and cholesterol metabolism are connected through sterol regulatory element-binding protein-2 (SREBP-2)","volume":"278","author":"Shin","year":"2003","journal-title":"J. Biol. Chem."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1038\/s41569-024-01111-0","article-title":"Apolipoprotein B-containing lipoproteins in atherogenesis","volume":"22","author":"Packard","year":"2025","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3731","DOI":"10.1210\/jc.2003-030039","article-title":"Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism: Beneficial effect of levothyroxine therapy","volume":"88","author":"Taddei","year":"2003","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1016\/S0022-3476(95)70180-X","article-title":"Effects of L-thyroxine on serum lipid profiles in infants with congenital hypothyroidism","volume":"127","author":"Asami","year":"1995","journal-title":"J. Pediatr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1016\/S0026-0495(99)90140-3","article-title":"Changes in serum apolipoprotein concentrations after L-thyroxine therapy in infants with congenital hypothyroidism","volume":"48","author":"Asami","year":"1999","journal-title":"Metabolism"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1046\/j.1442-200x.1999.01063.x","article-title":"Serum lipoproteins and apolipoprotein E in infants with congenital hypothyroidism","volume":"41","author":"Ciomartan","year":"1999","journal-title":"Pediatr. Int."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1046\/j.1442-200x.1999.01067.x","article-title":"Thyroxine inversely regulates serum intermediate density lipoprotein levels in children with congenital hypothyroidism","volume":"41","author":"Asami","year":"1999","journal-title":"Pediatr. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1515\/jpem-2016-0393","article-title":"Effects of L-thyroxine treatment on heart functions in infants with congenital hypothyroidism","volume":"30","author":"Arslan","year":"2017","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1161\/CIRCRESAHA.115.306301","article-title":"Endothelial cell dysfunction and the pathobiology of atherosclerosis","volume":"118","author":"Gimbrone","year":"2016","journal-title":"Circ. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1124\/pharmrev.120.000096","article-title":"Endothelial dysfunction in atherosclerotic cardiovascular diseases and beyond: From mechanism to pharmacotherapies","volume":"73","author":"Xu","year":"2021","journal-title":"Pharmacol. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1159\/000327369","article-title":"Von Willebrand factor, and soluble intercellular and vascular cell adhesion molecules as indices of endothelial activation in patients with congenital hypothyroidism","volume":"76","author":"Hashemipour","year":"2011","journal-title":"Horm. Res. Paediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1159\/000354688","article-title":"Aortic intima-media thickness in newborns with congenital hypothyroidism","volume":"80","author":"Akin","year":"2013","journal-title":"Horm. Res. Paediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1210\/jc.2007-2315","article-title":"Long-term cardiovascular effects of levothyroxine therapy in young adults with congenital hypothyroidism","volume":"93","author":"Salerno","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1530\/EJE-09-0674","article-title":"Effects of long-term L-thyroxine treatment on endothelial function and arterial distensibility in young adults with congenital hypothyroidism","volume":"162","author":"Oliviero","year":"2010","journal-title":"Eur. J. Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.pedneo.2024.04.015","article-title":"Abdominal aorta intima-media thickness in children with hypothyroidism","volume":"66","author":"Soliman","year":"2025","journal-title":"Pediatr. Neonatol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000502418","article-title":"Levothyroxine dosage as predictor of permanent and transient congenital hypothyroidism: A multicenter retrospective study in Japan","volume":"92","author":"Itonaga","year":"2019","journal-title":"Horm. Res. Paediatr."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Nguyen Quoc, A., Kariyawasam, D., Polak, M., Carr\u00e9, A., and Stoupa, A. (2026). Approach to the patient: Genetics and Management of Congenital Hypothyroidism. J. Clin. Endocrinol. Metab., dgag215.","DOI":"10.1210\/clinem\/dgag215"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s42000-020-00267-x","article-title":"Genetics of primary congenital hypothyroidism\u2014A review","volume":"20","author":"Kostopoulou","year":"2021","journal-title":"Hormones"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s12020-026-04663-y","article-title":"Comparison between liquid and tablet formulations in the treatment of congenital hypothyroidism","volume":"91","author":"Parzianello","year":"2026","journal-title":"Endocrine"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1089\/105072502753451968","article-title":"Effect of different starting doses of levothyroxine on growth and intellectual outcome at four years of age in congenital hypothyroidism","volume":"12","author":"Salerno","year":"2002","journal-title":"Thyroid"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"500","DOI":"10.14310\/horm.2002.1707","article-title":"Thyroid hormones: A potential ally to LDL-cholesterol-lowering agents","volume":"15","author":"Duntas","year":"2016","journal-title":"Hormones"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1532","DOI":"10.1093\/eurjpc\/zwag125","article-title":"Effectiveness and safety of treatment for heterozygous familial hypercholesterolaemia and multifactorial dyslipidaemia in children: An overview of systematic reviews","volume":"33","author":"Geist","year":"2026","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_32","first-page":"CD011748","article-title":"PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease","volume":"10","author":"Schmidt","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Ramesh, J., Tated, R., Agrawal, S.P., Maheta, D., Rajput, J., Ahmad, R., Frishman, W.H., and Aronow, W.S. (2025). Current state of pediatric hyperlipidemia: Epidemiology, management, and emerging therapies. Cardiol. Rev., Epub ahead of printing.","DOI":"10.1097\/CRD.0000000000001142"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e240327","DOI":"10.1530\/ETJ-24-0327","article-title":"Newborn screening for congenital hypothyroidism: Worldwide coverage 50 years after its start","volume":"14","author":"Arrigoni","year":"2025","journal-title":"Eur. Thyroid J."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/369\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:04:29Z","timestamp":1785837869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/8\/369"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":34,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcdd13080369"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13080369","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}