Heart rate variability in hypothyroid patients: A systematic review and meta-analysis

Valentin Brusseau, Igor Tauveron, Reza Bagheri, Ukadike Chris Ugbolue, Valentin Magnon, Valentin Navel, Jean-Baptiste Bouillon-Minois, Frederic Dutheil



Hypothyroidism may be associated with changes in the autonomic regulation of the cardiovascular system, which may have clinical implications.


Literature search

All studies measuring HRV in patients with untreated hypothyroidism and healthy controls were reviewed until August 20, 2021, on the major article databases (PubMed, Cochrane Library, Embase, and Google Scholar) with the following keywords: ("hypothyroidism" OR "hypothyroid") AND ("heart rate variability" OR "HRV"). We included all articles that met our inclusion criteria of measuring HRV parameters in hypothyroid patients and healthy controls, regardless of article language and year of publication. There were no restrictions on the regional origin or nature of the control group. We excluded studies evaluating the effect of treated hypothyroidism on HRV parameters, without HRV parameters in the time or frequency domain, without a control group, on animals, on children, conferences, congresses, or seminars. Studies had to be primary research. We manually searched the reference lists of all publications with our inclusion criteria to identify studies that would not have been found in the electronic search. We also performed searches within references of included articles or review found using our search strategy, to identify other potentially eligible primary studies. Our search strategy is shown in Fig 1 and S1 Fig. Two authors (VB and RB) conducted the literature searches, reviewed the abstracts and articles independently, checked suitability for inclusion, and extracted the data. When necessary, disagreements were solved with a third author (FD).


An initial search produced a possible 863 articles (Fig 1). The number of articles reporting the evaluation of HRV in untreated hypothyroidism was reduced to 17 after elimination of duplicates and use of the selection criteria [15–17, 37–48]. All included articles were written in English.
Among the 17 studies included, six studies were prospective [16, 17, 40–42, 44], nine were cross-sectional [15, 37, 38, 43, 45–50] and one was retrospective [39]. Included studies were published from 2000 to 2018 and conducted across 3 continents (Asia– 8 studies, Europe– 7 studies, America– 2 studies). All included articles compared HRV parameters of patients with untreated hypothyroidism and healthy controls [15–17, 37–48].


The main results showed a decreased HRV in patients with hypothyroidism that may be explained by the deleterious effect of TSH. The increase in sympathetic and decrease in parasympathetic activity may have clinical implications. Some other factors, such as age or BMI, should also be considered from a clinical perspective.


HRV is markedly decreased in hypothyroid patients. Increased sympathetic and decreased parasympathetic activity may be explained by molecular mechanisms involving catecholamines and by the effect of TSH on HRV parameters. The increased sympathetic and decreased parasympathetic activity may have clinical implications.

Citation: Brusseau V, Tauveron I, Bagheri R, Ugbolue UC, Magnon V, Navel V, et al. (2022) Heart rate variability in hypothyroid patients: A systematic review and meta-analysis. PLoS ONE 17(6): e0269277.

Editor: Daniel M. Johnson, The Open University, UNITED KINGDOM

Received: January 23, 2022; Accepted: May 17, 2022; Published: June 3, 2022

Copyright: © 2022 Brusseau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

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