# Association of thyroid nodules with comorbidity burden and prognosis in patients with heart failure, anemia, and hyperuricemia: a retrospective cohort study

## TL;DR

Thyroid nodules are linked to worse outcomes in heart failure patients with anemia and high uric acid, including more heart issues and depression.

## Contribution

This study identifies thyroid nodules as a marker for increased cardiovascular risk and depression in a high-risk heart failure population.

## Key findings

- Patients with thyroid nodules had higher rates of heart disease and atrial fibrillation.
- Depression was strongly associated with thyroid nodules and shorter survival times.
- Atrial fibrillation and diabetes were independent risk factors for poor outcomes.

## Abstract

The prognostic role of thyroid nodules (TNs) in patients with heart failure with reduced ejection fraction (HFrEF) complicated by anemia and hyperuricemia (HUA) remains unclear. This study aimed to investigate the association of TNs with cardiovascular comorbidity burden and long-term prognosis in this high-risk population.

A retrospective cohort of 185 inpatients with HFrEF, anemia, and HUA (2018-2022) was divided into TN (n=94) and non-TN (n=91) groups based on ultrasound findings. Baseline characteristics, laboratory parameters (thyroid function, coagulation), and psychological status (Hospital Anxiety and Depression Scale, HADS) were compared. The primary composite endpoint included all-cause mortality, heart failure rehospitalization, and cardiovascular events. Multivariable logistic and Cox regression analyses identified factors associated with TNs and prognosis.

The TN group had higher prevalence of coronary heart disease (65.9% vs 31.8%), atrial fibrillation (71.3%vs 27.5%), and depression scores (8.32 vs 6.02). Logistic regression identified depression (OR = 4.81, 95%CI 2.56-9.41), atrial fibrillation (OR = 4.46, 95%CI 2.09-9.51), and coronary heart disease (OR = 2.45, 95%CI 1.32-4.54) as independent factors associated with TNs. Depression and anxiety scores positively correlated with HbA1c (P<0.01) and negatively with NT-proBNP (P<0.05). During median follow-up of 21.8 months, 99.5% patients experienced adverse outcomes. Cox regression showed atrial fibrillation (HR = 1.95, 95%CI 1.35-2.80), diabetes (HR = 1.32, 95%CI 1.02-1.70), and prothrombin activity (HR = 1.01, 95%CI 1.00-1.01) as independent risk factors. Depression was associated with shorter median survival (14.0 vs 18.0 months).

Thyroid nodules are associated with greater cardiovascular comorbidity burden, depression, and poorer prognosis in HFrEF patients with anemia and HUA. This association highlights the need for comprehensive management that includes cardiovascular risk assessment and psychological evaluation.