ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Cardiovascular Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1652749
This article is part of the Research TopicMetabolic Pathways to Multiple Long-term Conditions (Multimorbidity): Focusing on Cardio-metabolic Multimorbidity (CMM)View all 13 articles
Association between peripheral thyroid sensitivity defined by the FT3/FT4 ratio and composite adverse outcome among inpatients with heart failure
Provisionally accepted
- 1Heze Municipal Hospital, Shandong, 274000, China, Heze, China
- 2Heze Hospital Affiliated to Shandong First Medical University, Heze, China
- 3Tianjin University Central Hospital, Tianjin, China
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Objective: The free triiodothyronine to free thyroxine (FT3/FT4) ratio is a indicator of peripheral thyroid hormone sensitivity. However, its prognostic value in heart failure (HF) remains unclear. Methods: This single center prospective cohort study included a total of 402 HF patients. The primary composite outcome was established as either mortality from any cause or HF-related hospitalization within one year. Multivariate Cox regression and Kaplan-Meier analysis assessed associations between the FT3/FT4 ratio and composite endpoint risks, with restricted cubic splines (RCS) exploring potential non-linear relationships. Results: Among 402 heart failure patients, 188 (46.8%) experienced the primary composite endpoint. The highest FT3/FT4 tertile (T3) had 38% lower risk than the lowest tertile (T1) (adjusted HR 0.62, 95% CI 0.41-0.94). In the subgroup of patients with subclinical hypothyroidism (SCH), T3 individuals showed an 84% lower risk compared to T1 (adjusted HR 0.16, 95% CI 0.03–0.81). Both the overall cohort and SCH subgroup exhibited a inverse association between FT3/FT4 ratios and adverse outcomes, whereas euthyroid patients demonstrated a U-shaped relationship with composite endpoint hazards (P for nonlinear = 0.004). Conclusions: Our findings suggest that maintaining or restoring higher FT3/FT4 levels may improve clinical outcomes in HF patients. Regular monitoring of this ratio, coupled with tailored interventions based on thyroid functional status, could enhance risk stratification and therapeutic decision-making.
Keywords: FT3/FT4 ratio, Heart Failure, Mortality, Readmission, peripheral thyroid sensitivity
Received: 24 Jun 2025; Accepted: 28 Aug 2025.
Copyright: © 2025 MA, MA, Gou and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: LI MA, Heze Municipal Hospital, Shandong, 274000, China, Heze, China
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