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Abucham J, Martins M. Subclinical central hypothyroidism in patients with hypothalamic-pituitary disease: does it exist? Rev Endocr Metab Disord 2024; 25:609-618. [PMID: 38324081 DOI: 10.1007/s11154-024-09876-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
Central hypothyroidism (CH) is characterized by decreased thyroid hormone production due to insufficient stimulation of an otherwise normal thyroid gland by TSH. In patients with established hypothalamic-pituitary disease, a low FT4 concentration is considered highly specific, although poorly sensitive, for the diagnosis of CH. That would be comparable to diagnosing primary hypothyroidism in patients at risk only when serum FT4 concentrations are below the reference range, missing all patients with subclinical primary hypothyroidism and preventing proper therapy in patients in which thyroxine replacement is clearly beneficial. Cardiac time intervals, especially the isovolumic contraction time (ICT), have been considered the gold standard of peripheral thyroid hormone action. Using Doppler echocardiography, we have previously shown a very high proportion of prolonged ICT in patients with hypothalamic-pituitary disease and serum FT4 levels indistinguishable from controls. As ICT decreased/normalized after thyroxine-induced increases in FT4 concentrations within the normal reference range, prolonged ICT was considered a bona fide diagnostic biomarker of subclinical CH. Those findings challenge the usual interpretation that FT4 concentrations in the mid-reference range exclude hypothyroidism in patients with hypothalamic-pituitary disease. Rather, subclinical central hypothyroidism, a state analogous to subclinical primary hypothyroidism, seems to be frequent in patients with hypothalamic-pituitary disease and normal FT4 levels. They also challenge the notion that thyroid function is usually the least or the last affected in acquired hypopituitarism. The relevance of Doppler echocardiography to correctly diagnose and monitor replacement therapy in both clinical and subclinical forms of CH should improve quality of life and decrease cardiovascular risk, as already demonstrated in patients with clinical and subclinical primary hypothyroidism.
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Affiliation(s)
- Julio Abucham
- Neuroendocrine Unit, Endocrinology Division, Escola Paulista de Medicina - Universidade Federal de São Paulo-UNIFESP, São Paulo, São Paulo, Brazil
| | - Manoel Martins
- Drug Research and Development Center, Department of Clinical Medicine, School of Medicine, Universidade Federal do Ceará-UFC, Fortaleza, Ceará, Brazil.
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Ittermann T, von Rheinbaben S, Markus MRP, Dörr M, Steveling A, Nauck M, Teumer A, Gollasch M, Spira D, König M, Demuth I, Steinhagen-Thiessen E, Völzke H, Stracke S. High Thyroid-Stimulating Hormone and Low Free Triiodothyronine Levels Are Associated with Chronic Kidney Disease in Three Population-Based Studies from Germany. J Clin Med 2023; 12:5763. [PMID: 37685830 PMCID: PMC10489120 DOI: 10.3390/jcm12175763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
High serum thyroid-stimulating hormone (TSH) levels have previously been associated with a low estimated glomerular filtration rate (eGFR), but studies associating thyroid hormone levels with albuminuria revealed inconsistent results. We used cross-sectional data from 7933 individuals aged 20 to 93 years of the Berlin Aging Study II and the Study of Health in Pomerania to associate serum TSH, fT3, and fT4 levels with eGFR and albuminuria. In multivariable analyses adjusted for confounding, we found inverse non-linear associations of serum TSH levels with eGFR, while serum fT3 levels showed a positive association with eGFR. High as well as low serum fT4 levels were associated with a lower eGFR. Age but not sex modified the association between thyroid hormone levels and eGFR. The inverse associations between serum TSH levels and eGFR were strongest in the youngest age groups, while the positive associations between serum fT3 levels and eGFR were strongest in older individuals. No significant associations between thyroid hormone levels and albuminuria were found. Our results indicate that hypothyroidism might be associated with a reduced kidney function. Thyroid function might be more tightly related to the eGFR than to albuminuria in the general population.
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Affiliation(s)
- Till Ittermann
- Institute for Community Medicine—SHIP Clinical-Epidemiological Research, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Sabrina von Rheinbaben
- Department of Medicine A—Gastroenterology, Nephrology, Endocrinology and Rheumatology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.v.R.); (A.S.); (S.S.)
| | - Marcello R. P. Markus
- Department of Internal Medicine B—Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, 17475 Greifswald, Germany; (M.R.P.M.); (M.D.)
| | - Marcus Dörr
- Department of Internal Medicine B—Cardiology, Intensive Care, Pulmonary Medicine and Infectious Diseases, University Medicine Greifswald, 17475 Greifswald, Germany; (M.R.P.M.); (M.D.)
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany; (M.N.); (A.T.)
| | - Antje Steveling
- Department of Medicine A—Gastroenterology, Nephrology, Endocrinology and Rheumatology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.v.R.); (A.S.); (S.S.)
| | - Matthias Nauck
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany; (M.N.); (A.T.)
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Alexander Teumer
- DZHK (German Center for Cardiovascular Research), Partner Site Greifswald, 17475 Greifswald, Germany; (M.N.); (A.T.)
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Maik Gollasch
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, 17475 Greifswald, Germany; (M.G.); (M.K.)
| | - Dominik Spira
- Department of Endocrinology and Metabolism, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (D.S.); (I.D.); (E.S.-T.)
| | - Maximilian König
- Department of Internal Medicine and Geriatrics, University Medicine Greifswald, 17475 Greifswald, Germany; (M.G.); (M.K.)
| | - Ilja Demuth
- Department of Endocrinology and Metabolism, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (D.S.); (I.D.); (E.S.-T.)
- BCRT—Berlin Institute of Health Center for Regenerative Therapies, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Department of Endocrinology and Metabolism, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (D.S.); (I.D.); (E.S.-T.)
| | - Henry Völzke
- Institute for Community Medicine—SHIP Clinical-Epidemiological Research, University Medicine Greifswald, 17475 Greifswald, Germany;
| | - Sylvia Stracke
- Department of Medicine A—Gastroenterology, Nephrology, Endocrinology and Rheumatology, University Medicine Greifswald, 17475 Greifswald, Germany; (S.v.R.); (A.S.); (S.S.)
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Karanth J, Vikram S, Mohanty S, Behera V, Ananthakrishnan R, Mahadev N. Short-term electrocardiographic and echocardiographic effects of levothyroxine replacement in adults with newly diagnosed hypothyroidism. JOURNAL OF MARINE MEDICAL SOCIETY 2023. [DOI: 10.4103/jmms.jmms_95_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Mire Waberi M, abdirahman S, Karataş M, Öcal L, Hassan MO, Awad I, Sheikh Hassan M. Overt hypothyroidism complicated by complete heart block and severe hyperlipidemia. A case report. Ann Med Surg (Lond) 2022; 84:104830. [PMID: 36582852 PMCID: PMC9793124 DOI: 10.1016/j.amsu.2022.104830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
Background Hypothyroidism can cause a variety of manifestations, including cardiovascular disorders. The most frequent clinical signs are sinus bradycardia and pericardial effusion. The affected patient generally has significant symptoms. Hypothyroidism infrequently results in a complete atrioventricular block. Case presentation A 19-year-old girl presented to our cardiology clinic with generalized tiredness, edema in her lower limbs and face, constipation, and a menstruation abnormality in the previous six months. With a normal ejection fraction on echocardiography, an electrocardiogram revealed complete atrioventricular block. When she was admitted, her laboratory testing showed that she had severely raised Thyroid Stimulating Hormone (TSH) levels, severe dyslipidemia with normal electrolytes, and normal liver and kidney function tests. The patient was treated with 50mg Thyroxine to her. She had significant improvement within two weeks of treatment. Up on the next follow-up (at one-month), her electrocardiogram returned to normal sinus rhythm without any evidence of atrioventricular block and that the lipid profile had returned to normal. Clinical discussion In its first stages, hypothyroidism can not show any obvious symptoms. Untreated hypothyroidism over time can lead to a variety of health issues, including obesity, joint discomfort, infertility, and heart disease. This current case demonstrates how levothyroxine medication successfully managed a young female patient's severe hypothyroidism, difficult total heart block, severe hyperlipidemia, and long-standing menstrual irregularity. Conclusion We found that overt hypothyroidism caused a complete atrioventricular block and severe dyslipidemia, and that thyroxin therapy completely corrected both conditions.
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Affiliation(s)
- Mohamud Mire Waberi
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia,Corresponding author.
| | - Said abdirahman
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mesut Karataş
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Lütfi Öcal
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Mohmed Omar Hassan
- Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
| | | | - Mohamed Sheikh Hassan
- Department of Neurology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia
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Akshay Kumar, Prabhu MM, Bhat N, Weena Stanley. A study of cardiovascular profile in patients with primary hypothyroidism. Biomedicine (Taipei) 2022. [DOI: 10.51248/.v42i4.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction and Aim: Raised cardiovascular morbidity is common among patients with primary hypothyroidism. Study of electrocardiogram (ECG) and echocardiography (ECHO) and correlation with lipid profile may help in early detection of cardiovascular diseases in hypothyroidism. By this study, we aimed at studying the cardiovascular profile in patients with primary hypothyroidism and correlating ECHO and ECG changes in primary hypothyroidism with the LDL cholesterol.
Materials and Methods: This was a single centre cross-sectional observational study. All patients diagnosed with primary hypothyroidism were included. The laboratory parameters pertaining to primary hypothyroidism were recorded. ECG and ECHO were noted and correlated with lipid profile.
Results: Total 240 subjects were selected according to inclusion and exclusion criteria, of which males were 25% and females 75%. Mean ± SD of LDL-C among subjects having ST-T changes was 160.98 ±14.86. Mean ± SD of LDL-C among subjects having no ST-T changes was 128±10.15. Unpaired student t test was used to compare mean of lipid profile in patient having ST-T changes with patients having no ST-T changes. A strong correlation was observed between LDL cholesterol and ST-T changes in ECG (P value =0.001)
Conclusion: Diastolic dysfunction is more common than systolic dysfunction in primary hypothyroidism. LDL levels were high in patients with primary hypothyroidism who had ST-T changes in electrocardiogram. Levothyroxine replacement causes decrease in Total as well as LDL cholesterol in primary hypothyroidism. ECG changes correlated with abnormal lipid profile in patients with primary hypothyroidism.
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Abstract
PURPOSE OF REVIEW Thyroid disorders, especially hypothyroidism, are known to be associated with pericardial diseases. The aim of this paper is to review the current knowledge of the pericardial manifestations of hypothyroidism and hyperthyroidism. RECENT FINDINGS Many reports have described associations between dysthyroidism, which encompasses hypothyroidism and hyperthyroidism, and several pericardial diseases, including acute pericarditis, constrictive pericarditis, pericardial effusion, and tamponade. The diagnosis of dysthyroidism-induced pericardial diseases consists of a combination of thyroid blood levels that fall outside of the normal range and the exclusion of other causes. Treatment of the thyroid disorder is key, along with treatment of the pericardial disease as recommended by the guidelines. Early recognition of the thyroid disorder is key in patients with pericardial diseases, since treating the underlying cause should assist resolution of the pericardial issues and ideally prevent recurrence and possible future complications of suboptimally treated pericarditis or pericardial effusions.
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Affiliation(s)
- Johnny Chahine
- Department of Cardiovascular Disease, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Zeina Jedeon
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kevin Y Chang
- Department of Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christine L Jellis
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
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Karki S, Rayamajhi RJ, Shikhrakar S, Shahi S, Dhakal B, Khadka M. Pericardial effusion in hypothyroidism: A case report. Ann Med Surg (Lond) 2021; 72:102999. [PMID: 34824834 PMCID: PMC8605303 DOI: 10.1016/j.amsu.2021.102999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction and importance: Hypothyroidism is an endocrine disorder with multiorgan involvement and various complications. One of the significant but less often seen complications is pericardial effusion. Since it can progress to life-threatening conditions like cardiac tamponade and hemodynamic instability, early diagnosis, and management of the pericardial effusion in hypothyroidism is a must. Case presentation We present a case of a 35-year-old male who presented with bilateral lower limb swelling, facial puffiness, cold intolerance, fatigue, and hoarseness of voice for one week. Laboratory investigation showed high thyroid-stimulating hormone (TSH), low triiodothyronine (T3), and raised serum anti-thyroid peroxidase (anti-TPO). The lipid profile demonstrated hypertriglyceridemia. Ultrasonography of the neck revealed normal thyroid size with decreased echo texture and increased vascularity. An electrocardiogram showed low voltage complexes with sinus bradycardia. 2D echocardiography revealed minimal pericardial effusion with normal ventricular function. The patient was managed with thyroxine therapy which gradually resolved his symptoms and pericardial effusion. Clinical discussion Pericardial effusion in hypothyroidism is due to the increased capillary permeability and albumin distribution volume and reduced lymph drainage in the pericardial cavity. Its presence in mild cases of hypothyroidism is uncommon although it can be seen in severe, long-standing hypothyroidism. Pericardial effusion in hypothyroidism, though rare, can present in mild cases and if overlooked can be fatal due to conditions like cardiac tamponade. Conclusion With early cardiac assessment and adequate thyroid replacement therapy, pericardial effusion in hypothyroidism can be reversible at an early stage. So, pericardial effusion which can be overlooked in mild cases of hypothyroidism needs to be identified and managed early. Hypothyroidism is an endocrine disorder with multiorgan involvement. Pericardial effusion is a notable complication of hypothyroidism, occurring due to the increased capillary permeability and albumin distribution volume and reduced lymph drainage in the pericardial cavity. The incidence of pericardial effusion is higher in severe, long-standing hypothyroidism whereas it’s uncommon in early stages and mild form of hypothyroidism. If presents earlier, with early cardiac assessment and adequate treatment, pericardial effusion can be reversible at an early stage.
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Affiliation(s)
- Saurab Karki
- Military Hospital, Sunsari, Nepal
- Corresponding author. Military Hospital, Itahari-4, Sunsari, Nepal.
| | | | | | | | | | - Manoj Khadka
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
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Yamakawa H, Kato TS, Noh JY, Yuasa S, Kawamura A, Fukuda K, Aizawa Y. Thyroid Hormone Plays an Important Role in Cardiac Function: From Bench to Bedside. Front Physiol 2021; 12:606931. [PMID: 34733168 PMCID: PMC8558494 DOI: 10.3389/fphys.2021.606931] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/28/2021] [Indexed: 01/07/2023] Open
Abstract
Thyroid hormones (THs) are synthesized in the thyroid gland, and they circulate in the blood to regulate cells, tissues, and organs in the body. In particular, they exert several effects on the cardiovascular system. It is well known that THs raise the heart rate and cardiac contractility, improve the systolic and diastolic function of the heart, and decrease systemic vascular resistance. In the past 30 years, some researchers have studied the molecular pathways that mediate the role of TH in the cardiovascular system, to better understand its mechanisms of action. Two types of mechanisms, which are genomic and non-genomic pathways, underlie the effects of THs on cardiomyocytes. In this review, we summarize the current knowledge of the action of THs in the cardiac function, the clinical manifestation and parameters of their hemodynamics, and treatment principles for patients with hyperthyroid- or hypothyroid-associated heart disease. We also describe the cardiovascular drugs that induce thyroid dysfunction and explain the mechanism underlying the thyroid toxicity of amiodarone, which is considered the most effective antiarrhythmic agent. Finally, we discuss the recent reports on the involvement of thyroid hormones in the regulation of myocardial regeneration and metabolism in the adult heart.
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Affiliation(s)
- Hiroyuki Yamakawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Center for Preventive Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko S. Kato
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | | | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Akio Kawamura
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, International University of Health and Welfare Narita Hospital, Chiba, Japan
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Cianciulli TF, Morita LA, Saccheri MC, Zylberman M. Hypothyroid cardiomyopathy: A reversible phenocopy of hypertrophic cardiomyopathy. Echocardiography 2021; 38:1673-1677. [PMID: 34510529 DOI: 10.1111/echo.15183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/22/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
We present the case of a 46-year-old patient with hypothyroidism secondary to Hashimoto's thyroiditis who was admitted with decompensation in the form of myxedema. A 2-D echocardiogram shows a septal asymmetric hypertrophy, with low-voltage QRS complex in the ECG and a bull's-eye map of longitudinal strain with preserved apical strain with reduction of mid and basal strain that results in "cherry on the top" pattern, similar to the most frequent phenocopy of hypertrophic cardiomyopathy, as is the cardiac amyloidosis, and that, unlike this pathology, reverted after the patient reached the euthyroid state.
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Affiliation(s)
- Tomás F Cianciulli
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Luis A Morita
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - María C Saccheri
- Cardiology Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
| | - Marcelo Zylberman
- Internal Medicine Department, Hospital of the Government of the City of Buenos Aires "Dr. Cosme Argerich", Buenos Aires, Argentina
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New-onset arrhythmia associated with patients hospitalized for thyroid dysfunction. Heart Lung 2020; 49:758-762. [PMID: 32979641 DOI: 10.1016/j.hrtlng.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thyroid dysfunction has been associated with cardiovascular dysfunction in the literature. However, the frequency of new-onset arrhythmias associated with thyroid disease hospitalization is unknown. Hence, we analyzed frequency, in-hospital outcomes, and resource utilization of new-onset arrhythmias associated with thyroid dysfunction hospitalizations. METHODS The patients who were admitted with the primary reason of thyroid dysfunction were included using appropriate international classification of disease, ninth revision, clinical modification (ICD-9-CM) codes. We then identified new-onset arrhythmias using appropriate ICD-9-CM codes. We utilized the "present on admission" variable to exclude arrhythmias that were present on admission. RESULTS Among the eligible patients with thyroid dysfunction, only 3% (n=12,111) developed a new-onset arrhythmia. Atrioventricular block (1.49%) is the most frequent followed by atrial fibrillation (0.92%), ventricular tachycardia (0.47%), atrial flutter (0.23%), supraventricular tachycardia (0.1%) and ventricular fibrillation (0.07%). Patients with new-onset arrhythmias were older (mean age 76.7±12.5 years), more predominantly white (n=9008, 74.4%), higher females (n= 7632, 63%), and had a higher frequency of comorbidities. In-hospital mortality occurred in 827 (6.8%) patients with new-onset arrhythmias and 8632 (2.2%) patients without new-onset arrhythmias (P-value <0.001). The medical length of stay and cost of hospitalization was also higher in these patients. CONCLUSION Thyroid dysfunction is not associated with significantly higher rates of new-onset arrhythmias while inpatient. However, when developed, these arrhythmias are associated with higher mortality and resource utilization. The patients admitted to the hospital should have thyroid function checked when found to have an arrhythmia.
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Silvestrini A, Mordente A, Martino G, Bruno C, Vergani E, Meucci E, Mancini A. The Role of Selenium in Oxidative Stress and in Nonthyroidal Illness Syndrome (NTIS): An Overview. Curr Med Chem 2020; 27:423-449. [PMID: 29421998 DOI: 10.2174/0929867325666180201111159] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/28/2022]
Abstract
Selenium is a trace element, nutritionally classified as an essential micronutrient, involved in maintaining the correct function of several enzymes incorporating the selenocysteine residue, namely the selenoproteins. The human selenoproteome including 25 proteins is extensively described here. The most relevant selenoproteins, including glutathione peroxidases, thioredoxin reductases and iodothyronine deiodinases are required for the proper cellular redox homeostasis as well as for the correct thyroid function, thus preventing oxidative stress and related diseases. This review summarizes the main advances on oxidative stress with a focus on selenium metabolism and transport. Moreover, thyroid-related disorders are discussed, considering that the thyroid gland contains the highest selenium amount per gram of tissue, also for future possible therapeutic implication.
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Affiliation(s)
- Andrea Silvestrini
- Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Largo F. Vito 1, Rome 00168, Italy
| | - Alvaro Mordente
- Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Largo F. Vito 1, Rome 00168, Italy
| | - Giuseppe Martino
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
| | - Carmine Bruno
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
| | - Edoardo Vergani
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
| | - Elisabetta Meucci
- Institute of Biochemistry and Clinical Biochemistry, School of Medicine, Catholic University, Largo F. Vito 1, Rome 00168, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, School of Medicine, Catholic University, Largo A. Gemelli 1, Rome, 00168, Italy
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Dizaye K, Mustafa ZA. The effect of eplerenone on the renin-angiotensin-aldosterone system of rats with thyroid dysfunction. J Pharm Pharmacol 2019; 71:1800-1808. [PMID: 31579950 PMCID: PMC6900172 DOI: 10.1111/jphp.13168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 09/01/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study was conducted to evaluate the effect of eplerenone on the RAAS and kidney function in rats with thyroid hormone disorders. METHODS This study involved 30 male Wistar albino rats, divided into three groups. The first group (N = 6) served as a control. The second group involved 12 rats with experimentally induced hypothyroidism through receiving propylthiouracil (0.05% w/v) in drinking water for one month, which was divided into two subgroups of six rats each. The first subgroup served as a positive hypothyroid control, and the second subgroup received oral daily dose of eplerenone (100 mg/kg) for 14 days. The third group included 12 rats with induced hyperthyroidism with L-thyroxin (0.0012% w/v) in drinking water, and rats in this group were also divided into two subgroups. The first subgroup served as a positive hyperthyroid control, and the second subgroup received oral eplerenone 100 mg/kg. RESULTS Eplerenone indicated a significant increase in renin and angiotensin I from 184.09 pg/ml and 178.66 pg/ml to 603.31 pg/ml and 250.88 pg/ml, respectively, meanwhile, aldosterone indicated no significant changes after inducing hypothyroidism and eplerenone administration. The induction of hyperthyroidism led to a significant increase in angiotensin I from 248.84 pg/ml to 292.22 pg/ml. Oral administration of eplerenone for 14 days caused a significant increase aldosterone from 364.23 pg/ml to 497.02 pg/ml. CONCLUSION Eplerenone significantly increased the serum renin and angiotensin I in hypothyroid and aldosterone and angiotensin I in hyperthyroid rats. Aldosterone in hypothyroid rats was not changed by eplerenone.
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Affiliation(s)
- Kawa Dizaye
- College of MedicineHawler Medical UniversityErbilIraq
| | - Zana A. Mustafa
- Department of PharmacyMedical Technical InstituteErbil Polytechnic UniversityErbilIraq
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Rastogi P, Dua A, Attri S, Sharma H. Hypothyroidism-induced reversible dilated cardiomyopathy. J Postgrad Med 2019; 64:177-179. [PMID: 29992912 PMCID: PMC6066629 DOI: 10.4103/jpgm.jpgm_154_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Dilated cardiomyopathy (DCM) is an idiopathic condition that results from impaired ventricular systolic function. Thyroid diseases have been known to cause myriad changes in the structure and function of the heart. Diastolic dysfunction is a common abnormality reported in hypothyroidism. However, hypothyroidism-induced DCM and systolic dysfunction is an uncommon phenomenon, especially as the initial presenting manifestation of hypothyroidism. The current article describes the case of a young female who presented with symptoms of heart failure and was diagnosed as having DCM as echocardiography revealed left ventricular global hypokinesia and severely depressed systolic function. Thyroid profile revealed a grossly elevated thyroid-stimulating hormone (TSH) value of 313 μIU/ml; free thyroxine (fT4) was 0.220 ng/dl. The present case presented with DCM as the initial presentation of hypothyroidism and improved significantly after five months of levothyroxine replacement therapy.
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Affiliation(s)
- P Rastogi
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - A Dua
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - S Attri
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
| | - H Sharma
- Department of Medicine, North DMC Medical College and Hindu Rao Hospital, New Delhi, India
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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High Prevalence of Antithyroid Antibodies in a New Zealand Cohort of Patients With Systemic Sclerosis. J Clin Rheumatol 2019; 24:264-271. [PMID: 29474198 DOI: 10.1097/rhu.0000000000000703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Autoimmune thyroid disease affects 1% of the general population, and autoimmune thyroid antibodies are noted in up to 15%. OBJECTIVE We hypothesized systemic sclerosis (SSc) is associated with higher prevalence of antithyroglobulin (anti-Tg) and anti-thyroid peroxidase (anti-TPO) antibodies) to justify monitoring of thyroid function for earlier detection and treatment. METHODS Waikato Hospital SSc clinic patients were prospectively tested for thyroid function tests and antithyroid antibodies (ATAs). RESULTS Of the 75 patients with SSc and 10 patients with SSc overlap syndrome (SOS) followed up in the SSc clinic, anti-Tg and anti-TPO were prospectively tested in 61 (70.6%) of the 85 patients. The cohort comprised 38 patients with limited cutaneous SSc (lcSSc), 15 with diffuse cutaneous SSc, and 8 with SOS.Anti-Tg and anti-TPO antibodies were found in 34.2% in lcSSc patients and 33.3% in diffuse cutaneous SSc patients, whereas in SOS they were found in 25% (Tg) and in 12.5% (TPO) of patients.At baseline, 10 patients (11.7%) had thyroid dysfunction: 8 (9.4%) with subclinical hypothyroidism and 1 each (1.2%) with subclinical hyperthyroidism and with clinical hyperthyroidism.After 18 months, 1 woman with lcSSc, positive for both ATAs, developed clinical hypothyroidism. CONCLUSIONS There is a higher prevalence of ATAs in SSc and SOS compared with the general population. Screening these patients for ATAs is a reasonable measure.
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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18
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Bastos MB, Massolt ET, Kam BLR, Peeters RP, Van Mieghem NM, Visser WE, den Uil CA. Pressure-volume analysis in athyroid patients off and on thyroxine supplementation: a pilot study. Physiol Rep 2018; 6:e13883. [PMID: 30350459 PMCID: PMC6198138 DOI: 10.14814/phy2.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 11/24/2022] Open
Abstract
Thyroid hormone importantly affects the cardiovascular system. However, evaluation of stroke volume (SV) and its determinants is confounded by variations in volume status that occur along different thyroid states. This study applied the pressure-volume (PV) framework to obtain relatively load-independent estimates of cardiac function in hypothyroidism as compared to euthyroidism. Ten athyroid patients were assessed echocardiographically after 4 weeks in deep hypothyroid state, and again after supplementation with oral Levothyroxine (LT4) for 3 months. Thyroid hormone levels were assessed and noninvasive pressure-volume (PV) analysis based on dedicated repeated echocardiograms was performed. Changes were assessed using paired tests. Results are presented as medians and interquartile ranges. Hypothyroidism was associated with reduced stroke volume (SV: 67.6 ± 17 vs. 75.7 ± 20.6 mL, P = 0.024), preload (end-diastolic volume, EDV: 122.6 ± 32.5 vs. 135.7 ± 33.6 mL, P = 0.004), and contractility (end-systolic elastance, Ees : 1.7 ± 0.33 vs. 2.58 ± 1.33 mmHg/mL, P = 0.01). Afterload was constant (effective arterial elastance, Ea : 1.66 ± 0.32 vs. 1.79 ± 0.52 mmHg/mL, P = 0.43) and the total energy spent was lower (PVA∙HR: 86.7 ± 28 vs. 110.9 ± 32.1 J, P = 0.04). Hemodynamic manifestations of frank hypothyroidism in humans are characterized by reduced preload and contractility, and unchanged total afterload. LT4 therapy increased work efficiency and heart rate, but not the net energy expenditure. Noninvasive PV analysis may be useful to follow-up different thyroid states.
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Affiliation(s)
| | - Elske T. Massolt
- Division of EndocrinologyErasmus MCRotterdamThe Netherlands
- Rotterdam Thyroid CenterDepartment of Internal MedicineErasmus MCRotterdamThe Netherlands
| | - Boen L. R. Kam
- Department of Nuclear MedicineErasmus MCRotterdamThe Netherlands
| | - Robin P. Peeters
- Division of EndocrinologyErasmus MCRotterdamThe Netherlands
- Rotterdam Thyroid CenterDepartment of Internal MedicineErasmus MCRotterdamThe Netherlands
| | | | - W. Edward Visser
- Division of EndocrinologyErasmus MCRotterdamThe Netherlands
- Rotterdam Thyroid CenterDepartment of Internal MedicineErasmus MCRotterdamThe Netherlands
| | - Corstiaan A. den Uil
- Department of CardiologyErasmus MCRotterdamThe Netherlands
- Department of Intensive CareErasmus MCRotterdamThe Netherlands
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Han YH, Jeong HJ, Sohn MH, Lee SY, Lim ST. Radioiodine ablation in thyroid cancer patients: renal function and external radiation dose rate at discharge according to patient preparation. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018. [PMID: 29521481 DOI: 10.23736/s1824-4785.18.03029-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND An elevated thyroid stimulating hormone (TSH) level is essential for the uptake of radioiodine into thyroid remnants and residual thyroid cancer in patients undergoing high-dose radioiodine therapy (HD-RIT). Recently, the use of recombinant human thyroid stimulating hormone (rh-TSH) has increased in preference over the conventional method of thyroid hormone withdrawal (THW). However, the clinical influences of the two methods, aside from the therapeutic effects, have not been widely evaluated. The aim of this work was to investigate the influences of the two methods, particularly on the renal function and external radiation dose rate (EDR) from patients undergoing HD-RIT. METHODS From February 2012 to November 2016, 667 patients (M:F=138:529, mean age: 47.7±11.8 years), who underwent first HD-RIT (120, 150, or 180 mCi, 1 mCi=37 MBq) for ablation of remnant thyroid tissue or residual thyroid cancer, were enrolled. Patients who were proven to have distant metastasis to lung or bone were excluded. Low- to high-risk patients based on 2015 American thyroid association management guidelines who underwent first HD-RIT in our department were included. The period from total thyroidectomy to HD-RIT was limited within 12 months. The following parameters were collected and evaluated: age, gender, histology type and TNM stage of thyroid cancer, glomerular filtration rate on the admission day for total thyroidectomy (baseline GFR), GFR on the day of HD-RIT (follow-up GFR), thyroglobulin (Tg) and TSH levels on the day of HD-RIT, and EDR on the discharge day after HD-RIT. RESULTS There were 386 patients using the THW method and 281 patients choosing the rh-TSH method. The baseline GFR of the THW group (106±16 mL/min/1.73 m2) and that of the rh-TSH group (104±17 mL/min/1.73 m2) were within normal limits and there was no significant difference. However, follow-up GFR of the THW group (84±17 mL/min/1.73 m2) was much lower than that of the rh-TSH group (104±16 mL/min/1.73 m2) (P=0.000). In the THW group, the follow-up GFR decreased significantly (P=0.000), yet the follow-up GFR of the rh-TSH group was not statistically different when compared with its baseline GFR (P=0.142). EDRs were lower in all rh-TSH subgroups compared to those of THW subgroups with statistical significance. Tg and TSH levels were not different between the two groups, excluding a few small-sized subgroups analyses. CONCLUSIONS In this retrospective analysis of renal function and EDR, the use of rh-TSH appears to help maintain renal function and finally decrease EDR in contrast to the THW method when undergoing HD-RIT.
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Affiliation(s)
- Yeon-Hee Han
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Hwan-Jeong Jeong
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Myung-Hee Sohn
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea
| | - Sun Y Lee
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, South Korea.,Department of Radiation Oncology, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea
| | - Seok T Lim
- Department of Nuclear Medicine, Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Jeonbuk, South Korea - .,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, South Korea.,Cyclotron Research Center, Jeonju, Jeonbuk, South Korea.,Molecular Imaging and Therapeutic Medicine Research Center, Jeonju, Jeonbuk, South Korea
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20
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Mujer, corazón y tiroides. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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21
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Polat Canbolat I, Belen E, Bayyigit A, Helvaci A, Kilickesmez K. Evaluation of Daily Blood Pressure Alteration in Subclinical Hypothyroidism. ACTA CARDIOLOGICA SINICA 2017; 33:489-494. [PMID: 28959101 PMCID: PMC5611345 DOI: 10.6515/acs20170220b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 02/20/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Subclinical hypothyroidism is the most common thyroid dysfunction in the general population. The relationship between overt thyroid dysfunction and hypertension is generally understood. Besides high blood pressure, non-dipper hypertension is known to increase cardiovascular risk. Our aim is to investigate daily blood pressure changes and the frequency of non-dipping patterns in patients with subclinical hypothyroidism. METHODS Forty-nine patients without hypertension with subclinical hypothyroidism were compared with 50 healthy sex- and age-matched controls using ambulatory blood pressure monitoring. RESULTS Thyroid-stimulating hormone (TSH) levels were significantly higher in the subclinic hypothyroidism group, and there was no difference between free triiodothyronine (FT3) and free thyroxine (FT4) levels which could be predicted as a result of the study design. Levels of mean diastolic, daytime diastolic, nighttime diastolic and nighttime systolic blood pressure were significantly higher in the subclinic hypothyroidism group (p = 0.001 for mean, daytime and nighttime diastolic and p = 0.01 for nighttime systolic). Diastolic non-dipping occurred more frequently in the subclinic hypothyroidism group [subclinical hypothyroidism group 24 patients (49%), control group 13 patients (26%), p = 0.01]. On multivariate analysis, subclinical hypothyroidism was independently associated with diastolic non-dipping (95% confidence interval 1.162-8.053, odds ratio 1.182, p = 0.024). CONCLUSIONS Our study found that both the frequency of diastolic non-dipping pattern and diastolic blood pressure increase with subclinical hypothyroidism. Therfore, it would appear that searching for non-dipping pattern can add valuable information for patients with subclinical hypothyroidism.
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Affiliation(s)
| | | | - Akif Bayyigit
- Department of Internal Medicine, Okmeydani Training and Research Hospital
| | | | - Kadriye Kilickesmez
- Department of Cardiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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22
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Chon SJ, Heo JY, Yun BH, Jung YS, Seo SK. Serum Thyroid Stimulating Hormone Levels Are Associated with the Presence of Coronary Atherosclerosis in Healthy Postmenopausal Women. J Menopausal Med 2016; 22:146-153. [PMID: 28119894 PMCID: PMC5256366 DOI: 10.6118/jmm.2016.22.3.146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/08/2016] [Accepted: 08/16/2016] [Indexed: 12/25/2022] Open
Abstract
Objectives Menopause is a natural aging process causing estrogen deficiency, accelerating atherogenic processes including dyslipidemia. Prevalence of thyroid dysfunction is also high in postmenopausal women, and it is known to elevate the risk of cardiovascular disease (CVD). Therefore, we are to study on the associations in between serum thyroid stimulating hormone (TSH) and prevalence of CVD in postmenopausal women who have normal thyroid function. Methods We performed a retrospective review of 247 Korean postmenopausal women who visited the health promotion center from January, 2007 to December, 2009. Postmenopausal women with normal serum TSH were included in the study. Coronary atherosclerosis was assessed by 64-row multidetector computed tomography. Results In multiple linear regression analysis, serum TSH was associated with serum triglyceride (TG) (β = 0.146, P = 0.023). In multiple logistic regression analysis, increasing age and serum TSH were associated with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women (odds ratio [OR] = 1.107 [1.024-1.197], P = 0.011 and OR = 1.303 [1.024-1.658], P = 0.031, respectively). Conclusions It revealed that significant predictor of serum TSH was serum TG, and increasing age and TSH were found to have associations with an increased risk of coronary atherosclerosis in euthyroid postmenopausal women. Screening and assessing risks for CVD in healthy postmenopausal women would be helpful before atherosclerosis develops.
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Affiliation(s)
- Seung Joo Chon
- Department of Obstetrics and Gynecology, Gil Hospital, Gachon University College of Medicine, Incheon, Korea
| | - Jin Young Heo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Bo Hyon Yun
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon Soo Jung
- Department of Obstetrics and Gynecology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seok Kyo Seo
- Department of Obstetrics and Gynecology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.; Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Bozkurt B, Colvin M, Cook J, Cooper LT, Deswal A, Fonarow GC, Francis GS, Lenihan D, Lewis EF, McNamara DM, Pahl E, Vasan RS, Ramasubbu K, Rasmusson K, Towbin JA, Yancy C. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e579-e646. [PMID: 27832612 DOI: 10.1161/cir.0000000000000455] [Citation(s) in RCA: 440] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
PURPOSE OF REVIEW Hypothyroidism is highly prevalent in chronic kidney disease (CKD) patients, including those receiving dialysis. This review examines potential mechanistic links between thyroid and kidney disease; current evidence for hypothyroidism as a risk factor for de novo CKD and CKD progression; and studies of thyroid functional disorders, cardiovascular disease, and death in the CKD population. RECENT FINDINGS Epidemiologic data have demonstrated an incrementally higher prevalence of hypothyroidism with increasing severity of kidney dysfunction. Various thyroid functional test abnormalities are also commonly observed in CKD due to alterations in thyroid hormone synthesis, metabolism, and regulation. Although the mechanistic link between thyroid and kidney disease remains unclear, observational studies suggest that hypothyroidism is associated with abnormal kidney structure and function. Previously thought to be a physiologic adaptation, recent studies show that hypothyroidism is associated with higher risk of cardiovascular disease and death in CKD. SUMMARY A growing body of evidence suggests that hypothyroidism is a risk factor for incident CKD, CKD progression, and higher death risk in kidney disease patients. Rigorous studies are needed to determine the impact of thyroid hormone replacement upon kidney disease progression, cardiovascular disease, and mortality, which may shed light onto the causal implications of hypothyroidism in CKD.
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Affiliation(s)
- Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, United States
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Sanghi V, Kapoor A. Unusual Presentation of Central Diabetes Insipidus in a Patient With Neurosarcoidosis. J Investig Med High Impact Case Rep 2016; 4:2324709616667511. [PMID: 27652275 PMCID: PMC5019196 DOI: 10.1177/2324709616667511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 01/03/2023] Open
Abstract
Hypernatremia is a frequent cause of intensive care unit admission. The patient presented in this article had hypernatremia refractory to D5W (dextrose 5% water) therapy, which led to a complex investigation. Workup revealed central diabetes insipidus most likely secondary to flare up of neurosarcoidosis. The challenge in terms of diagnosis was a presentation with low urine output in the setting of hypernatremia resistant to treatment with desmopressin. This case unfolded the role of hypothyroidism causing secondary renal dysfunction and hence needed continued treatment with thyroxine in addition to treatment for hypernatremia.
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Affiliation(s)
- Vedha Sanghi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Aanchal Kapoor
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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Xu G, Yan W, Li J. An update for the controversies and hypotheses of regulating nonthyroidal illness syndrome in chronic kidney diseases. Clin Exp Nephrol 2014; 18:837-43. [DOI: 10.1007/s10157-014-0974-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/05/2014] [Indexed: 12/24/2022]
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Seol MD, Lee YS, Kim DK, Choi YH, Kim DJ, Park SH, Cho HJ, Cho WH. Dilated cardiomyopathy secondary to hypothyroidism: case report with a review of literatures. J Cardiovasc Ultrasound 2014; 22:32-5. [PMID: 24753807 PMCID: PMC3992346 DOI: 10.4250/jcu.2014.22.1.32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 11/12/2013] [Accepted: 02/18/2014] [Indexed: 11/22/2022] Open
Abstract
To date, it has been well documented that there is a relationship between alterations in thyroid hormones and cardiac dysfunction. We experienced a case of a 36-year-old man with dilated cardiomyopathy (DCM) accompanied by undiagnosed primary hypothyroidism. In the current case, there was a significant improvement in the cardiac function following heart failure management and thyroid hormone replacement. Our case highlights that clinicians should consider the possibility of hypothyroidism as a cause of DCM.
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Affiliation(s)
- Myung Do Seol
- Division of Cardiology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
| | - Young Soo Lee
- Division of Cardiology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
| | - Dong Keun Kim
- Division of Cardiology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
| | - Young Hoon Choi
- Division of Cardiology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
| | - Dong-Ju Kim
- Division of Cardiology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
| | - Sun Hee Park
- Division of Endocrinology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
| | - Hye Jae Cho
- Department of Pathology, Sahmyook Seoul Hospital, Seoul, Korea
| | - Wook Hyun Cho
- Division of Cardiology, Department of Internal Medicine, Sahmyook Seoul Hospital, Seoul, Korea
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Kim EO, Lee IS, Choi YA, Lee SJ, Chang YK, Yoon HE, Jang YS, Lee JM, Kim HS, Yang CW, Kim SY, Hwang HS. Unresolved subclinical hypothyroidism is independently associated with progression of chronic kidney disease. Int J Med Sci 2014; 11:52-9. [PMID: 24396286 PMCID: PMC3880991 DOI: 10.7150/ijms.7186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/11/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND AIM Patients with chronic kidney disease (CKD) often have subclinical hypothyroidism. However, few reports have investigated changes in the status of subclinical hypothyroidism in CKD patients and its clinical significance in CKD progression. METHODS We included 168 patients with nondialysis-dependent CKD stages 2-4. The normalization of subclinical hypothyroidism during follow-up was assessed, and the association between transitions in subclinical hypothyroid status and the rate of decline of the estimated glomerular filtration rate (eGFR) was investigated. RESULTS At baseline, 127 patients were euthyroid and 41 (24.4%) patients were diagnosed with subclinical hypothyroidism. Of these 41 patients, 21 (51.2%) spontaneously resolved to euthyroid during follow-up. The rate of eGFR decline of patients with resolved subclinical hypothyroidism was similar to that of euthyroid patients. The patients with unresolved subclinical hypothyroidism showed a steeper renal function decline than patients with euthyroidism or resolved subclinical hypothyroidism (all p < 0.05). The progression to end-stage renal disease was more frequent in those with unresolved subclinical hypothyroidism than in those who were euthyroid (p = 0.006). In multivariate linear regression for rate of eGFR decrease, unresolved subclinical hypothyroidism (β = -5.77, p = 0.001), baseline renal function (β = -0.12, p < 0.001) and level of proteinuria (β = -2.36, p = 0.015) were independently associated with the rate of renal function decline. CONCLUSIONS Half of the CKD patients with subclinical hypothyroidism did not resolve to euthyroidism, and this lack of resolution was independently associated with rapid renal function decline.
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Affiliation(s)
- Eun Oh Kim
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ihn Suk Lee
- 2. Division of Endocrinology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoo A Choi
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Ju Lee
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Kyung Chang
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Eun Yoon
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yi Sun Jang
- 2. Division of Endocrinology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Min Lee
- 2. Division of Endocrinology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hye Soo Kim
- 2. Division of Endocrinology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Woo Yang
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Suk Young Kim
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon Seok Hwang
- 1. Division of Nephrology, Departments of Internal Medicine, The Catholic University of Korea, Seoul, Korea
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Erdogan E, Akkaya M, Bacaksiz A, Tasal A, İlhan M, Kul S, Asoglu E, Turfan M, Sonmez O, Tasan E. Electrocardiographic and echocardiographic evidence of myocardial impairment in patients with overt hypothyroidism. ANNALES D'ENDOCRINOLOGIE 2013; 74:477-82. [DOI: 10.1016/j.ando.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/28/2013] [Accepted: 10/07/2013] [Indexed: 01/19/2023]
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Frey A, Kroiss M, Berliner D, Seifert M, Allolio B, Güder G, Ertl G, Angermann CE, Störk S, Fassnacht M. Prognostic impact of subclinical thyroid dysfunction in heart failure. Int J Cardiol 2013; 168:300-5. [DOI: 10.1016/j.ijcard.2012.09.064] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Revised: 07/24/2012] [Accepted: 09/15/2012] [Indexed: 10/27/2022]
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Shin DH, Lee MJ, Lee HS, Oh HJ, Ko KI, Kim CH, Doh FM, Koo HM, Kim HR, Han JH, Park JT, Han SH, Yoo TH, Kang SW. Thyroid hormone replacement therapy attenuates the decline of renal function in chronic kidney disease patients with subclinical hypothyroidism. Thyroid 2013; 23:654-61. [PMID: 23281965 PMCID: PMC3675831 DOI: 10.1089/thy.2012.0475] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Subclinical hypothyroidism (SCH) is not a rare condition in females, the elderly, or patients with chronic kidney disease (CKD). Even though previous studies have demonstrated that thyroid hormone replacement therapy (THRT) improves cardiac function and dyslipidemia in patients with SCH, it remains unclear as to whether THRT can improve renal function in CKD patients with SCH. This study investigated the impact of THRT on changes in estimated glomerular filtration rates (eGFR) in this patient population. METHODS A total of 113 CKD patients with SCH who were treated with L-thyroxine and had eGFR available for at least 24 months before and after THRT were enrolled between January 2005 and December 2011. A linear mixed model was used to compare patients' clinical and biochemical parameters at various time points. The slope of the decline in eGFR over time, both before and after THRT, was also calculated and compared using a linear mixed model. RESULTS The mean age of the study participants was 63.2±12.7 years, and 36 patients (31.9%) were men. The mean follow-up duration before and after THRT was 28.6±4.5 and 30.6±6.4 months respectively. After 24 months of THRT, serum thyrotropin (TSH) levels were significantly reduced-8.86±0.49 versus 1.41±0.73 μIU/mL, p<0.001-but there were no significant changes in triiodothyronine and free thyroxine concentrations. Serum albumin, calcium, phosphate, cholesterol, and triglyceride levels were also comparable before and after THRT. The rates of decline in eGFR were significantly attenuated by THRT (-4.31±0.51 vs.-1.08±0.36 [mL/min]/[year·1.73 m²], p<0.001), even after adjustment for age, sex, diabetes, mean arterial pressure, and serum albumin, cholesterol, and triglyceride concentrations (p<0.001). CONCLUSION THRT attenuated the rate of decline in renal function in CKD patients with SCH, suggesting that THRT may delay reaching end-stage renal disease in these patients.
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Affiliation(s)
- Dong Ho Shin
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - Mi Jung Lee
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, College of Medicine, Yonsei University, Seoul, South Korea
| | - Hyung Jung Oh
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Kwang Il Ko
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Chan Ho Kim
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Fa Mee Doh
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Hyang Mo Koo
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Hyoung Rae Kim
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Jae Hyun Han
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Jung Tak Park
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Seung Hyeok Han
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
| | - Shin-Wook Kang
- Department of Internal Medicine, Yonsei University, Seoul, South Korea
- Severance Biomedical Science Institute Brain Korea 21, Yonsei University, Seoul, South Korea
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Meena CL, Meena RD, Nawal R, Meena VK, Bharti A, Meena LP. Assessment of left ventricular diastolic dysfunction in sub-clinical hypothyroidism. Acta Inform Med 2013; 20:218-20. [PMID: 23378686 PMCID: PMC3558289 DOI: 10.5455/aim.2012.20.21-218-220] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/23/2012] [Indexed: 11/27/2022] Open
Abstract
Background: Adverse cardiovascular effect of hypothyroidism has been identified in many studies. Early identification of patients with sub-clinical hypothyroidism may lead to early treatment and thereby favourable effect on cardiovascular morbidity and mortality. Objectives: To find out the association of sub clinical hypothyroidism and left ventricular dysfunction and also to find out relationship between systolic and diastolic dysfunction in these patients. Material and Methods: A total 30 cases of sub clinical hypothyroidism along with 15 age sex matched healthy control subjects were included in study. Serum TSH, T4, T3 hormone level was measured and those who were found to have sub-clinical hypothyroidism underwent for 2DEcho. Results: Significant reduction in peak early filling velocity (PE) (p<0.001) and early filling time velocity integral (Ei) (p<0.001). Ratio of early and late peak velocities (PE/PA) (p<0.001), ratio of time velocity integral of early and atrial filling (Ei/Ai) (p<0.001) and ratio of the early peak to average velocity (PE/M) (p<0.001) were also reduced. Mean EF was 54.9± 5.55 as compared to 55.7 ± 3.46 of control subjects with a T.value of 0.48 ,however there was significant diastolic dysfunction in case of hypothyroid patients (mean Ei/Ai = 1.35 ± 0.53) as compared to control group subjects (mean Ei/AI = 2.11 ± 0.26) with a T value of 5.22. Conclusion: Sub-clinical hypothyroidism showed significant diastolic dysfunction in the absence of significant impairment of systolic function.
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Affiliation(s)
- C L Meena
- Department of General Medicine, SMS Medical college, Jaipur, India
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Sabih DE, Inayatullah M. Managing thyroid dysfunction in selected special situations. Thyroid Res 2013; 6:2. [PMID: 23379325 PMCID: PMC3626556 DOI: 10.1186/1756-6614-6-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 01/30/2013] [Indexed: 01/16/2023] Open
Abstract
Managing thyroid dysfunction is simple at first glance, the idea is to bring hormone levels in the euthyroid range, treat with antithyroid drugs, radio-iodine or surgery if toxic and replace with thyroxine or T3 if hypothyroid. Complexities arise when there are coexisting conditions that affect the thyroid or are affected by thyroid dysfunction and this review will deal with the special situations that need care when correcting thyroid hormone levels.
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Affiliation(s)
- Durr E Sabih
- Multan Institute of Nuclear Medicine and Radiotherapy, Nishtar Hospital, Multan 60000, Pakistan.
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Hypothyroidism complicating nephropathy in a diabetes patient. Case Rep Endocrinol 2012; 2012:237563. [PMID: 23304572 PMCID: PMC3529430 DOI: 10.1155/2012/237563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/11/2012] [Indexed: 01/06/2023] Open
Abstract
We describe a patient with type 2 diabetes mellitus and autoimmune hypothyroidism who presented with elevated serum creatinine possibly due to subclinical rhabdomyolysis induced by hypolipidemic drug therapy in the background of diabetic nephropathy. Both hypothyroidism and rhabdomyolysis were asymptomatic in this case as evidenced by lack of classical clinical features of hypothyroidism despite elevated serum TSH and absent pigment cast in renal biopsy. The combination of diabetes mellitus and hypothyroidism is common in the general population and should not be forgotten in patients with diabetes and kidney disease.
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Thyroid hormone replacement therapy for primary hypothyroidism leads to significant improvement of renal function in chronic kidney disease patients. Clin Exp Nephrol 2012; 17:525-31. [PMID: 23160649 DOI: 10.1007/s10157-012-0727-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND The interactions between kidney and thyroid functions have been known for many years; however, there are few studies on the extent of the improvements and long-term changes of renal function after thyroid hormone replacement therapy (THRT) in chronic kidney disease (CKD) patients. The purpose of this study was to determine how THRT affects the estimated glomerular filtration rate (eGFR) in CKD patients with primary hypothyroidism. METHODS A retrospective investigation was performed on 51 Japanese patients (15 men and 36 women) with primary hypothyroidism. The changes in eGFR after THRT were examined according to the existence of CKD and severity of thyroid function. RESULTS eGFR increased rapidly over the first 6 months after THRT in CKD patents, which was followed by a plateau. There was a correlation between eGFR and the severity of hypothyroidism, which was independent of age, and eGFR in severely hypothyroid patients significantly increased up to levels that were similar to mildly hypothyroid patients after THRT. eGFR improved more in the lower initial eGFR group and increased about 30 % in CKD patients (47.5 ± 7.7 vs. 62.1 ± 9.5 ml/min/1.73 m(2), P < 0.01). Moreover, eGFR in CKD patients with mild to moderate hypothyroidism was significantly increased compared to that in non-CKD patients. CONCLUSION Our data suggested that hypothyroidism contributed to the reduction in eGFR, especially in CKD patients; therefore, patients with CKD should positively be examined for thyroid function, and appropriate THRT should be started if needed.
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Seol SH, Kim DI, Park BM, Kim DK, Song PS, Kim KH, Jin HY, Seo JS, Jang JS, Yang TH, Kim DK, Kim DS. Complete Atrioventricular Block Presenting With Syncope Caused by Severe Hypothyroidism. Cardiol Res 2012; 3:239-241. [PMID: 28348695 PMCID: PMC5358139 DOI: 10.4021/cr221w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/28/2022] Open
Abstract
A 75-year-old man was admitted to our hospital with syncope. Electrocardiogram showed complete atrioventricular block and bradycardia with the minimum heart rate of 22 beats/ min. There was a possible indication for temporary cardiac pacemaker implantation. Laboratory data on admission revealed high TSH level with low free T4 level. To rule out functional atrioventricular block, we treated several days with thyroxine. A follow-up electrocardiogram showed improved heart rate without any atrioventricular block. We found that severe hypothyroidism caused a complete atrioventricular block with syncope, and thyroxine replacement completely improved these conditions.
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Affiliation(s)
- Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Bo-Min Park
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Pil-Sang Song
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Ki-Hun Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Han-Young Jin
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dong-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Shin DH, Lee MJ, Kim SJ, Oh HJ, Kim HR, Han JH, Koo HM, Doh FM, Park JT, Han SH, Yoo TH, Kang SW. Preservation of renal function by thyroid hormone replacement therapy in chronic kidney disease patients with subclinical hypothyroidism. J Clin Endocrinol Metab 2012; 97:2732-40. [PMID: 22723335 DOI: 10.1210/jc.2012-1663] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Subclinical hypothyroidism is not a rare condition, but the use of thyroid hormone to treat subclinical hypothyroidism is an issue of debate. OBJECTIVE This study was undertaken to investigate the impact of thyroid hormone therapy on the changes in estimated glomerular filtration rate (eGFR) in subclinical hypothyroidism patients with stage 2-4 chronic kidney disease. PATIENTS A total of 309 patients were included in the final analysis. MAIN OUTCOME MEASURE The changes in eGFR over time were compared between patients with and without thyroid hormone replacement therapy using a linear mixed model. Kaplan-Meier curves were constructed to determine the effect of thyroid hormone on renal outcome, a reduction of eGFR by 50%, or end-stage renal disease. The independent prognostic value of subclinical hypothyroidism treatment for renal outcome was ascertained by multivariate Cox regression analysis. RESULTS Among the 309 patients, 180 (58.3%) took thyroid hormone (treatment group), whereas 129 (41.7%) did not (nontreatment group). During the mean follow-up duration of 34.8 ± 24.3 months, the overall rate of decline in eGFR was significantly greater in the nontreatment group compared to the treatment group (-5.93 ± 1.65 vs. -2.11 ± 1.12 ml/min/yr/1.73 m(2); P = 0.04). Moreover, a linear mixed model revealed that there was a significant difference in the rates of eGFR decline over time between the two groups (P < 0.01). Kaplan-Meier analysis also showed that renal event-free survival was significantly lower in the nontreatment group (P < 0.01). In multivariate Cox regression analysis, thyroid hormone replacement therapy was found to be an independent predictor of renal outcome (hazard ratio, 0.28; 95% CI, 0.12-0.68; P = 0.01). CONCLUSION Thyroid hormone therapy not only preserved renal function better, but was also an independent predictor of renal outcome in chronic kidney disease patients with subclinical hypothyroidism.
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Affiliation(s)
- Dong Ho Shin
- Department of Internal Medicine, College of Medicine, Yonsei University, Seoul 120-752, Korea
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Mansourian AR. A literature review on the adverse effects of hypothyroidism on kidney function. Pak J Biol Sci 2012; 15:709-719. [PMID: 24171256 DOI: 10.3923/pjbs.2012.709.719] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Thyroid produce two important hormone of thyroxine or tetraidothyronine (T4) and triidothyronine (T3), which are involved in whole aspect of metabolism. T4 and T3 play vital role in all biochemical function, growth and development in human body. The basic metabolic pathways in kidney and every organ in human controlled by these hormones. T4 and T3 are involved in kidney function in health and diseases condition therefore the pathophysiology of kidney can be directly influenced and regulated by thyroid hormones. Kidney growth, haemodynamic, blood circulation, tubular, electrolyte balance and glomerular filtration rate (GFR) are among such crucial process. Hypothyroidism which accompanied with reduced thyroid hormone production adversely affect the renal functions, development and eventually leading to reduced weight, kidney vascular disorders, electrolyte, tubular transport imbalances, lower filtration rate and other adverse consequences of hypothyroidism. On other hand kidney diseases can also disrupt the thyroid function metabolism resulting in the subsequent hypothyroidism. It is an interesting subject in how thyroid and kidney in health and diseases closely interacted. For the ideal clinical follow up of either of thyroid and renal diseases the two organs should be simultaneously examined for a proper patient management. Close correlation of thyroid and kidney clinical teams are essential to check the cross reactions and adverse interactions which might be produced between these two vital organs to avoid misdiagnosis either of thyroid or kidney abnormalities.
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Affiliation(s)
- Azad Reza Mansourian
- Department of Biochemistry, Metabolic Disorders Research Center, Gorgan Medical School, Golestan University of Medical Sciences, Gorgan, Iran
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Nakamura RK, Russell NJ, Shelton GD. Adult-onset nemaline myopathy in a dog presenting with persistent atrial standstill and primary hypothyroidism. J Small Anim Pract 2012; 53:357-60. [DOI: 10.1111/j.1748-5827.2012.01221.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Doin FC, Rosa-Borges M, Martins MRA, Moisés VA, Abucham J. Diagnosis of subclinical central hypothyroidism in patients with hypothalamic-pituitary disease by Doppler echocardiography. Eur J Endocrinol 2012; 166:631-40. [PMID: 22267279 DOI: 10.1530/eje-11-0907] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The diagnosis of subclinical central hypothyroidism in hypothalamic-pituitary patients cannot be established by serum markers of thyroid hormone action. Myocardial function by echocardiography has been shown to reflect thyroid hormone action in primary thyroid dysfunction. We evaluated the performance of echocardiography in diagnosing subclinical central hypothyroidism. DESIGN Cross-sectional and before and after. METHODS Echocardiography and serum thyroid hormones were assessed in overt primary (n=20) and central (n=10) hypothyroidism, subclinical primary hypothyroidism (n=10), hypothalamic-pituitary disease with normal free thyroxine (FT(4); n=25), and controls (n=28). Receiver operating characteristic (ROC) curves were generated using overt hypothyroidism patients and selected cut-off values were applied to detect both primary and central subclinical hypothyroidism. After levothyroxine (l-T(4)) intervention, patients were echocardiographically reevaluated at predefined targets: normal thyrotropin (TSH) in primary hypothyroidism, normal FT(4) in overt central hypothyroidism, and higher than pretreatment FT(4) in echo-defined subclinical central hypothyroidism. RESULTS Parameters with highest areas under the ROC curves (area under the curve (AUC) ≥0.94) were as follows: isovolumic contraction time (ICT), ICT/ejection time (ET), and myocardial performance index. Highest diagnostic accuracy (93%) was obtained when at least one parameter was increased (positive and negative predictive values: 93%). Hypothyroidism was echocardiographically diagnosed in eight of ten patients with subclinical primary hypothyroidism and in 14 of 25 patients (56%) with hypothalamic-pituitary disease and normal serum FT(4). Echocardiographic abnormalities improved significantly after l-T(4) and correlated (0.05<P<0.001) with changes in FT(4) (-0.62<r<-0.55) and TSH (0.63<r<0.68) in primary hypothyroidism and with FT(4) in central hypothyroidism (-0.72<r<-0.50). CONCLUSION Echocardiography can be useful in diagnosing subclinical central hypothyroidism in patients with hypothalamic-pituitary disease.
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Affiliation(s)
- Fabio Casanova Doin
- Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Abstract
There are several interactions between thyroid and kidney functions in each other organ's disease states. Thyroid hormones affect renal development and physiology. Thyroid hormones have pre-renal and intrinsic renal effects by which they increase the renal blood flow and the glomerular filtration rate (GFR). Hypothyroidism is associated with reduced GFR and hyperthyroidism results in increased GFR as well as increased renin - angiotensin - aldosterone activation. Chronic kidney disease (CKD) is characterized by a low T3 syndrome which is now considered a part of an atypical nonthyroidal illness. CKD patients also have increased incidence of primary hypothyroidism and subclinical hypothyroidism. The physiological benefits of a hypothyroid state in CKD, and the risk of CKD progression with hyperthyroidism emphasize on a conservative approach in the treatment of thyroid hormone abnormalities in CKD. Thyroid dysfunction is also associated with glomerulonephritis often by a common autoimmune etiology. Several drugs could affect both thyroid and kidney functions. There are few described interactions between thyroid and renal malignancies. A detailed knowledge of all these interactions is important for both the nephrologists and endocrinologists for optimal management of the patient.
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Affiliation(s)
- Gopal Basu
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjali Mohapatra
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Zang J, Wu S, Tang L, Xu X, Bai J, Ding C, Chang Y, Yue L, Kang E, He J. Incidence and risk of QTc interval prolongation among cancer patients treated with vandetanib: a systematic review and meta-analysis. PLoS One 2012; 7:e30353. [PMID: 22363427 PMCID: PMC3281826 DOI: 10.1371/journal.pone.0030353] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 12/14/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Vandetanib is a multikinase inhibitor that is under assessment for the treatment of various cancers. QTc interval prolongation is one of the major adverse effects of this drug, but the reported incidence varies substantially among clinical trials. We performed a systematic review and meta-analysis to obtain a better understanding in the risk of QTc interval prolongation among cancer patients administered vandetanib. METHODOLOGY AND PRINCIPAL FINDINGS Eligible studies were phase II and III prospective clinical trials that involved cancer patients who were prescribed vandetanib 300 mg/d and that included data on QTc interval prolongation. The overall incidence and risk of QTc interval prolongation were calculated using random-effects or fixed-effects models, depending on the heterogeneity of the included studies. Nine trials with 2,188 patients were included for the meta-analysis. The overall incidence of all-grade and high-grade QTc interval prolongation was 16.4% (95% CI, 8.1-30.4%) and 3.7% (8.1-30.4%), respectively, among non-thyroid cancer patients, and 18.0% (10.7-28.6%) and 12.0% (4.5-28.0%), respectively, among thyroid cancer patients. Patients with thyroid cancer who had longer treatment duration also had a higher incidence of high-grade events, with a relative risk of 3.24 (1.57-6.71), than patients who had non-thyroid cancer. Vandetanib was associated with a significantly increased risk of all-grade QTc interval prolongation with overall Peto odds ratios of 7.26 (4.36-12.09) and 5.70 (3.09-10.53) among patients with non-thyroid cancer and thyroid cancer, respectively, compared to the controls. CONCLUSIONS/SIGNIFICANCE Treatment with vandetanib is associated with a significant increase in the overall incidence and risk of QTc interval prolongation. Different cancer types and treatment durations may affect the risk of developing high-grade QTc interval prolongation.
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Affiliation(s)
- Jiajie Zang
- Department of Health Statistics and Center of Evidence-based Medicine, Second Military Medical University, Shanghai, China
| | - Shunquan Wu
- Department of Health Statistics and Center of Evidence-based Medicine, Second Military Medical University, Shanghai, China
| | - Lei Tang
- Department of Health Statistics and Center of Evidence-based Medicine, Second Military Medical University, Shanghai, China
| | - Xudong Xu
- Cardiology Department, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jie Bai
- Department of Geriatrics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Caicui Ding
- Library of First Hospital, Peking University, Beijing, China
| | - Yue Chang
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Long Yue
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Enming Kang
- Department of Endocrinology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics and Center of Evidence-based Medicine, Second Military Medical University, Shanghai, China
- * E-mail:
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Deegan RJ, Furman WR. Cardiovascular Manifestations of Endocrine Dysfunction. J Cardiothorac Vasc Anesth 2011; 25:705-20. [DOI: 10.1053/j.jvca.2010.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Indexed: 01/27/2023]
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Westerink J, van der Graaf Y, Faber DR, Spiering W, Visseren FLJ. Relation between thyroid-stimulating hormone and the occurrence of cardiovascular events and mortality in patients with manifest vascular diseases. Eur J Prev Cardiol 2011; 19:864-73. [DOI: 10.1177/1741826711416045] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Aims: To investigate whether levels of thyroid-stimulating hormone (TSH) within the normal range are associated with an increased risk of new vascular events and mortality in patients with clinical manifest vascular diseases and whether this relation is influenced by adiposity. Methods and results: Prospective cohort study in 2443 patients (1790 men and 653 women) with clinical manifest vascular disease and TSH levels in the normal range. Median follow up was 2.7 (interquartile range 1.4–3.9) years. Clinical endpoints of interest were: myocardial infarction, stroke, vascular death, and all-cause mortality. In patients with manifest vascular disease, the prevalence of (subclinical) hypothyroidism was 5.7%, while 3.6% had (subclinical) hyperthyroidism. An increase in 1 unit of TSH was associated with a 33% higher risk (HR 1.33; 95% CI 1.03–1.73) for the occurrence of myocardial infarction, adjusted for age, gender, renal function, and smoking. In patients with a body mass index (BMI) below the median of 26.7 kg/m2 the HR per unit TSH for myocardial infarction was 1.55 (95% CI 1.08–2.21) compared to 1.18 (95% CI 0.81–1.71) in patients with a BMI ≥26.7 kg/m2. Visceral adipose tissue thickness below the median (≤8.8 cm) was associated with higher HR per unit TSH for myocardial infarction (HR 1.69; 95% CI 1.21–2.35) compared to visceral adipose tissue thickness >8.9 cm (HR 1.00; 95% CI 0.66–1.49). There was no relation between TSH and risk of stroke, vascular death, the combined endpoint, or all-cause mortality. Conclusion: Higher TSH levels within the normal range are associated with an increased risk of myocardial infarction, in patients with clinical manifest vascular disease. This relation is most prominent in patients without visceral obesity.
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Affiliation(s)
- Jan Westerink
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Daniël R Faber
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wilko Spiering
- University Medical Center Utrecht, Utrecht, The Netherlands
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Jain V, Kannan L, Kumar P. Congenital hypopituitarism presenting as dilated cardiomyopathy in a child. J Pediatr Endocrinol Metab 2011; 24:767-9. [PMID: 22145472 DOI: 10.1515/jpem.2011.366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital hypopituitarism is commonly diagnosed either in infancy with neonatal hypoglycemia, prolonged jaundice and/or microphallus or in early to mid-childhood because of short stature. Replacement of deficient hormones allows the affected children to have a normal and productive life. We describe a 10-year-old boy with congenital hypopituitarism whose parents first sought definitive medical attention when the child developed congestive heart failure due to dilated cardiomyopathy, presumably secondary to prolonged untreated central hypothyroidism and growth hormone deficiency.
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Affiliation(s)
- Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
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Pearce EN, Yang Q, Benjamin EJ, Aragam J, Vasan RS. Thyroid function and left ventricular structure and function in the Framingham Heart Study. Thyroid 2010; 20:369-73. [PMID: 20210671 PMCID: PMC2867586 DOI: 10.1089/thy.2009.0272] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Thyroid hormone acts on the heart and peripheral vasculature in multiple ways. Even in patients with subclinical hypo- or hyperthyroidism, subclinical alterations in left ventricular (LV) structure and function may be associated with important clinical effects. Our objective was to determine whether thyroid function is related to echocardiographic indices of LV structure and function. METHODS Cross-sectional association of serum thyroid-stimulating hormone (TSH) with two-dimensional-guided M-mode echo LV dimensions and function. Participants were 1376 Framingham Heart Study participants (61% women, mean age 69 years) who attended a routine examination 1979-1981. We excluded participants with myocardial infarction or heart failure, renal insufficiency, and missing data, and those using thyroid hormone or antithyroid medications. Serum TSH was measured 1977-1979. The following echocardiographic measurements were analyzed both as continuous variables and dichotomized at the top quintile: LV end-diastolic dimensions, LV wall thickness, LV mass, LV fractional shortening (an indicator of systolic function), and left atrial diameter. Sex-specific multiple regression models were adjusted for age, height, weight, blood pressure, heart rate, total to high-density lipoprotein cholesterol ratio, and the presence of diabetes, hypertension treatment, and valve disease. RESULTS In multivariable linear models, log-TSH was not related to LV mass, LV wall thickness, or left atrial size in either sex, or to LV systolic function in men. Log-TSH had a borderline inverse association with fractional shortening (p = 0.06) in women. In multivariable logistic models, women with TSH <0.5 mU/L (n = 81) had a greater odds of being in the highest quintile of fractional shortening compared to euthyroid subjects (odds ratio 2.2, 95% confidence interval 1.3-3.8, p = 0.01). CONCLUSIONS In our moderate-sized community-based sample, TSH concentration was not associated with LV structure in either sex, but was inversely related to LV contractility, consistent with the known inotropic effects of thyroid hormone.
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Cini G, Carpi A, Mechanick J, Cini L, Camici M, Galetta F, Giardino R, Russo M, Iervasi G. Thyroid hormones and the cardiovascular system: Pathophysiology and interventions. Biomed Pharmacother 2009; 63:742-53. [DOI: 10.1016/j.biopha.2009.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Accepted: 08/24/2009] [Indexed: 10/20/2022] Open
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Di Bello V, Talini E, Donne MGD, Aghini-Lombardi F, Monzani F, La Carrubba S, Antonini-Canterin F, Dini FL, Di Salvo G, Carerj S, Marzilli M. New Echocardiographic Techniques in the Evaluation of Left Ventricular Mechanics in Subclinical Thyroid Dysfunction. Echocardiography 2009; 26:711-9. [DOI: 10.1111/j.1540-8175.2008.00875.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bhardwaj R. Hypothyroidism Presenting as Dilated Cardiomyopathy. Med J Armed Forces India 2009; 65:284-6. [DOI: 10.1016/s0377-1237(09)80031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 02/26/2009] [Indexed: 11/24/2022] Open
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Lien E, Aanderud S. Systolic time intervals in the evaluation of thyroid dysfunction. ACTA MEDICA SCANDINAVICA 2009; 211:265-8. [PMID: 7102364 DOI: 10.1111/j.0954-6820.1982.tb01942.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Systolic time intervals, the pre-ejection period (PEP), left ventricular ejection time (LVET) and PEP/LVET ratio were studied in ten thyrotoxic and ten hypothyroid patients. LVET and PEP intervals were corrected for heart rate (LVETc and PEPc). The measurements were repeated after 1-28 months when the patients were euthyroid following appropriate therapy. Compared with the euthyroid values, the PEPc intervals and PEP/LVET ratios were significantly decreased (p less than 0.01) in the thyrotoxic and increased (p less than 0.001) in the hypothyroid patients. In both groups the LVETc intervals were significantly prolonged (p less than 0.001). In four of the hypothyroid patients the PEP/LVET ratios were markedly increased (above 0.60, mean 0.66), and above 0.41 in the euthyroid state (reference value 0.35 +/- 0.05). In the other hypothyroid patients and in thyrotoxic patients the euthyroid PEP/LVET ratios were within the reference values. The systolic time intervals were not influenced by propranolol therapy in the thyrotoxic patients. Our results suggest increased myocardial contractility unaffected by adrenergic blockade in thyrotoxicosis, and reduced contractility in hypothyroidism.
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